The Effect of Chest Compression and Ventilation Coordination During Cardiopulmonary Resuscitation.

The Effect of Chest Compression and Ventilation Coordination During Cardiopulmonary Resuscitation

Airway management and maintaining adequate ventilation during cardiopulmonary resuscitation (CPR) are important. The rule of 30:2 compression-to-ventilation ratios before endotracheal intubation and keeping 1 breath every 6-8 seconds with advanced airway are generally accepted according to 2010 Advanced Cardiac Life Support (ACLS) guideline. This recommendation emphasizes on the timing and frequency of ventilation during CPR. However, poor clinical evidence had been established concerning adequate volume, airway flow and pressure in each cycle.

There are increasing evidence that hyperventilation during resuscitation reduces pulmonary venous return and, therefore, compromises cardiac output and circulation. Another research reported that using high flow oxygen mask alone during basic life support (BLS) results in better survival rate and overall outcome compared with conventional positive pressure ventilation.

Our study applies flowmeter to measure ventilation parameters as frequency, duration, exhaled volume and airway pressure on intubated patients who received artificial ventilation during CPR. The parameters will correlate with information from accelerometry and capnometry simultaneously during resuscitation. . Investigators also focus on the influence of chest compression, which increases intra-thoracic pressure considerably. This effect may act against positive pressure ventilation and probably minimize the efficiency in each ventilation or circulation..

Details about how to ventilate one patient during CPR include right timing, duration, adequate volume and coordination are in debate. Unfortunately, current practice based on clinical guidelines emphasizes little on this issue. Investigators are committed to refine contemporary practices and hopefully improve qualities of resuscitation.

Investigators proposed the hypothesis that coordinate chest compression and ventilation may minimize the increasement of airway pressure and improve the effect of circulation

Study Overview

• Status: Unknown
• Conditions: Out-of-Hospital Cardiac Arrest; Sudden Cardiac Death

• Study Type: Observational
• Enrollment (Anticipated): 50

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan, 10002
    • Recruiting
    • National Taiwan University Hospital
    • Contact: Hui-Chih Wang; Phone Number: 65659 +886-2-23123456; Email: ticoer@ntuh.gov.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Cardiac arrest patient received CPR in Emergency Department Age > 20 years old

Description

Inclusion Criteria:

• age > 20 years old, < 100 years old

Exclusion Criteria:

• Trauma related out of hospital cardiac arrest

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Out of hospital cardiac arrest; Out of hospital cardiac arrest of non-traumatic cause
Unexpected in-hospital cardiac arrest; Unexpected cardiac arrest during emergency department stay

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
rate of 2- hour recover of spontaneous circulation	Recover of spontaneous circulation lasting for 2 hours describe as successful recover of spontaneous circulation, otherwise failure.	2 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
End tidal carbon-dioxide level	End tidal carbon-dioxide level correlates with successful recovery of spontaneous circulation event	Measured during and end of resuscitation
Arterial blood gas data	Oxygen and carbon-dioxide tension changes in different ventilation strategy in cardiopulmonary resuscitation	measured during and end of resuscitaiton
30-day survival rate		30 days
90-day neurologic outcome		90 days
Survive to discharge	Duration of hospital stay, usually will be recorded in 90 days, occasionally will more than 90 days	90 days
Timing of first shockable rhythm		measured during resuscitaion

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Investigators: Principal Investigator: Hui-Chih Wang, Emergency department, National Taiwan University Hospital

Study record dates

Study Major Dates

• Study Start: October 1, 2013
• Primary Completion (Actual): February 1, 2015
• Study Completion (Anticipated): July 1, 2015

Study Registration Dates

• First Submitted: January 21, 2014
• First Submitted That Met QC Criteria: February 4, 2014
• First Posted (Estimate): February 6, 2014

Study Record Updates

• Last Update Posted (Estimate): April 3, 2015
• Last Update Submitted That Met QC Criteria: April 1, 2015
• Last Verified: April 1, 2015

More Information

Terms related to this study

• Keywords: cardiopulmonary resuscitation,Ventilation
• Additional Relevant MeSH Terms: Pathologic Processes; Heart Diseases; Cardiovascular Diseases; Death, Sudden; Heart Arrest; Death; Out-of-Hospital Cardiac Arrest; Death, Sudden, Cardiac
• Other Study ID Numbers: 201305100RINB