Ricardo Luiz Cordioli1, Laurent Brochard2, Laurent Suppan3, Aissam Lyazidi4, François Templier5, Abdo Khoury6, Stephane Delisle7, Dominique Savary8, Jean-Christophe Richard8,9. 1. Hospital Israelita Albert Einstein, Intensive Care Unit, Sao Paulo, Brazil, and Hospital Alemão Oswaldo Cruz, Intensive Care Unit, Sao Paulo, Brazil. rlcordioli@gmail.com. 2. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada, and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Geneva University Hospitals, Division of Emergency Medicine, Geneva, Switzerland. 4. Institut Supérieur des Sciences de la Santé, Laboratory Rayonnement-Matiére et Instrumentation, Université Hassan 1er, Settat, Morocco. 5. University Hospital of Angers, SAMU 49, Emergency Department, Angers, France. 6. University Hospital of Besançon, Besançon, France. 7. Hôpital du Sacré-Cœur de Montréal, Service des Soins Intensifs, Québec, Canada. 8. General Hospital of Annecy, SAMU 74 and Emergency Department, Annecy, France. 9. INSERM UMR 955 Eq13 Créteil, France.
Abstract
BACKGROUND: Recommendations regarding ventilation during cardiopulmonary resuscitation (CPR) are based on a low level of scientific evidence. We hypothesized that practices about ventilation during CPR might be heterogeneous and may differ worldwide. To address this question, we surveyed physicians from several countries on their practices during CPR. METHODS: We used a Web-based opinion survey. Links to the survey were sent by e-mail newsletters and displayed on the Web sites of medical societies involved in CPR practice from December 2013 to March 2014. RESULTS: 1,328 surveys were opened, and 548 were completed (41%). Responses came from 54 countries, but 64% came from 6 countries. Responders were mostly physicians (89%). From this group, 97% declared following specific CPR guidelines. Regarding practices, 28% declared always or frequently adopting only continuous chest compressions without additional ventilation. With regard to mechanical chest compression devices, 38% responded that such devices were available to them; when used, 28% declared always or frequently experiencing problems with ventilation such as frequent alarms. During bag-mask ventilation in intubated patients, 18% declared stopping chest compression during insufflation, and 39% applied > 10 breaths/min, which conflicts with international CPR guidelines. When a ventilator was used, the volume controlled mode was the most common strategy cited, but there was heterogeneity regarding ventilator settings for PEEP, trigger, FIO2 , and breathing frequency. SpO2 and end-tidal CO2 were the 2 most monitored variables cited. CONCLUSIONS: Physicians indicated heterogeneous practices that often differ significantly from international CPR guidelines. This may reflect the low level of evidence and a lack of detailed recommendations concerning ventilation during CPR.
BACKGROUND: Recommendations regarding ventilation during cardiopulmonary resuscitation (CPR) are based on a low level of scientific evidence. We hypothesized that practices about ventilation during CPR might be heterogeneous and may differ worldwide. To address this question, we surveyed physicians from several countries on their practices during CPR. METHODS: We used a Web-based opinion survey. Links to the survey were sent by e-mail newsletters and displayed on the Web sites of medical societies involved in CPR practice from December 2013 to March 2014. RESULTS: 1,328 surveys were opened, and 548 were completed (41%). Responses came from 54 countries, but 64% came from 6 countries. Responders were mostly physicians (89%). From this group, 97% declared following specific CPR guidelines. Regarding practices, 28% declared always or frequently adopting only continuous chest compressions without additional ventilation. With regard to mechanical chest compression devices, 38% responded that such devices were available to them; when used, 28% declared always or frequently experiencing problems with ventilation such as frequent alarms. During bag-mask ventilation in intubated patients, 18% declared stopping chest compression during insufflation, and 39% applied > 10 breaths/min, which conflicts with international CPR guidelines. When a ventilator was used, the volume controlled mode was the most common strategy cited, but there was heterogeneity regarding ventilator settings for PEEP, trigger, FIO2 , and breathing frequency. SpO2 and end-tidal CO2 were the 2 most monitored variables cited. CONCLUSIONS: Physicians indicated heterogeneous practices that often differ significantly from international CPR guidelines. This may reflect the low level of evidence and a lack of detailed recommendations concerning ventilation during CPR.
Authors: Francis M Lapid; Caitlin E O'Brien; Sapna R Kudchadkar; Jennifer K Lee; Elizabeth A Hunt; Raymond C Koehler; Donald H Shaffner Journal: Paediatr Anaesth Date: 2020-01-27 Impact factor: 2.556