Clinical and hemodynamic comparison of 15: 2 and 30:2 compression-to- ventilation ratios for cardiopulmonary resuscitation

Demetris Yannopoulos, Tom P. Aufderheide, Andrea Gabrielli, David G. Beiser, Scott H. McKnite, Ronald G. Pirrallo, Jane Wigginton, Lance Becker, Terry Vanden Hoek, Wanchun Tang, Vinay M. Nadkarni, John P. Klein, Ahamed H. Idris, Keith G. Lurie

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objective: To compare cardiopulmonary resuscitation (CPR) with a compression to ventilation (C:V) ratio of 15:2 vs. 30:2, with and without use of an impedance threshold device (ITD). Design: Prospective randomized animal and manikin study. Setting: Animal laboratory and emergency medical technician training facilities. Subjects: Twenty female pigs and 20 Basic Life Support (BLS)-certified rescuers. Interventions, Measurements, and Main Results: Animals: Acid-base status, cerebral, and cardiovascular hemodynamics were evaluated in 18 pigs in cardiac arrest randomized to a C:V ratio of 15:2 or 30:2. After 6 mins of cardiac arrest and 6 mins of CPR, an ITD was added. Compared to 15:2, 30:2 significantly increased diastolic blood pressure (20 ± 1 to 26 ± 1; p < .01); coronary perfusion pressure (18 ± 1 to 25 ± 2; p = .04); cerebral perfusion pressure (16 ± 3 to 18 ± 3; p = .07); common carotid blood flow (48 ± 5 to 82 ± 5 mL/min; p < .001); end-tidal CO2 (7.7 ± 0.9 to 15.7 ± 2.4; p < .0001); and mixed venous oxygen saturation (26 ± 5 to 36 ± 5, p < .05). Hemodynamics improved further with the ITD. Oxygenation and arterial pH were similar. Only one of nine pigs had return of spontaneous circulation with 15:2, vs. six of nine with 30:2 (p < 0.03). Humans: Fatigue and quality of CPR performance were evaluated in 20 BLS-certified rescuers randomized to perform CPR for 5 mins at 15:2 or 30:2 on a recording CPR manikin. There were no significant differences in the quality of CPR performance or measurement of fatigue. Significantly more compressions per minute were delivered with 30:2 in both the animal and human studies. Conclusions: These data strongly support the contention that a ratio of 30:2 is superior to 15:2 during manual CPR and that the ITD further enhances circulation with both C:V ratios.

Original languageEnglish (US)
Pages (from-to)1444-1449
Number of pages6
JournalCritical Care Medicine
Volume34
Issue number5
DOIs
StatePublished - May 2006

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Cardiopulmonary Resuscitation
Ventilation
Hemodynamics
Electric Impedance
Manikins
Equipment and Supplies
Swine
Heart Arrest
Fatigue
Cerebrovascular Circulation
Emergency Medical Technicians
Blood Pressure
Laboratory Animals
Perfusion
Oxygen
Pressure
Acids

Keywords

  • Cardiopulmonary resuscitation
  • Hemodynamics
  • Impedance threshold device
  • Perfusion
  • Ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Yannopoulos, D., Aufderheide, T. P., Gabrielli, A., Beiser, D. G., McKnite, S. H., Pirrallo, R. G., ... Lurie, K. G. (2006). Clinical and hemodynamic comparison of 15: 2 and 30:2 compression-to- ventilation ratios for cardiopulmonary resuscitation. Critical Care Medicine, 34(5), 1444-1449. https://doi.org/10.1097/01.CCM.0000216705.83305.99

Clinical and hemodynamic comparison of 15 : 2 and 30:2 compression-to- ventilation ratios for cardiopulmonary resuscitation. / Yannopoulos, Demetris; Aufderheide, Tom P.; Gabrielli, Andrea; Beiser, David G.; McKnite, Scott H.; Pirrallo, Ronald G.; Wigginton, Jane; Becker, Lance; Vanden Hoek, Terry; Tang, Wanchun; Nadkarni, Vinay M.; Klein, John P.; Idris, Ahamed H.; Lurie, Keith G.

In: Critical Care Medicine, Vol. 34, No. 5, 05.2006, p. 1444-1449.

Research output: Contribution to journalArticle

Yannopoulos, D, Aufderheide, TP, Gabrielli, A, Beiser, DG, McKnite, SH, Pirrallo, RG, Wigginton, J, Becker, L, Vanden Hoek, T, Tang, W, Nadkarni, VM, Klein, JP, Idris, AH & Lurie, KG 2006, 'Clinical and hemodynamic comparison of 15: 2 and 30:2 compression-to- ventilation ratios for cardiopulmonary resuscitation', Critical Care Medicine, vol. 34, no. 5, pp. 1444-1449. https://doi.org/10.1097/01.CCM.0000216705.83305.99
Yannopoulos, Demetris ; Aufderheide, Tom P. ; Gabrielli, Andrea ; Beiser, David G. ; McKnite, Scott H. ; Pirrallo, Ronald G. ; Wigginton, Jane ; Becker, Lance ; Vanden Hoek, Terry ; Tang, Wanchun ; Nadkarni, Vinay M. ; Klein, John P. ; Idris, Ahamed H. ; Lurie, Keith G. / Clinical and hemodynamic comparison of 15 : 2 and 30:2 compression-to- ventilation ratios for cardiopulmonary resuscitation. In: Critical Care Medicine. 2006 ; Vol. 34, No. 5. pp. 1444-1449.
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AU - Beiser, David G.

AU - McKnite, Scott H.

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AU - Wigginton, Jane

AU - Becker, Lance

AU - Vanden Hoek, Terry

AU - Tang, Wanchun

AU - Nadkarni, Vinay M.

AU - Klein, John P.

AU - Idris, Ahamed H.

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N2 - Objective: To compare cardiopulmonary resuscitation (CPR) with a compression to ventilation (C:V) ratio of 15:2 vs. 30:2, with and without use of an impedance threshold device (ITD). Design: Prospective randomized animal and manikin study. Setting: Animal laboratory and emergency medical technician training facilities. Subjects: Twenty female pigs and 20 Basic Life Support (BLS)-certified rescuers. Interventions, Measurements, and Main Results: Animals: Acid-base status, cerebral, and cardiovascular hemodynamics were evaluated in 18 pigs in cardiac arrest randomized to a C:V ratio of 15:2 or 30:2. After 6 mins of cardiac arrest and 6 mins of CPR, an ITD was added. Compared to 15:2, 30:2 significantly increased diastolic blood pressure (20 ± 1 to 26 ± 1; p < .01); coronary perfusion pressure (18 ± 1 to 25 ± 2; p = .04); cerebral perfusion pressure (16 ± 3 to 18 ± 3; p = .07); common carotid blood flow (48 ± 5 to 82 ± 5 mL/min; p < .001); end-tidal CO2 (7.7 ± 0.9 to 15.7 ± 2.4; p < .0001); and mixed venous oxygen saturation (26 ± 5 to 36 ± 5, p < .05). Hemodynamics improved further with the ITD. Oxygenation and arterial pH were similar. Only one of nine pigs had return of spontaneous circulation with 15:2, vs. six of nine with 30:2 (p < 0.03). Humans: Fatigue and quality of CPR performance were evaluated in 20 BLS-certified rescuers randomized to perform CPR for 5 mins at 15:2 or 30:2 on a recording CPR manikin. There were no significant differences in the quality of CPR performance or measurement of fatigue. Significantly more compressions per minute were delivered with 30:2 in both the animal and human studies. Conclusions: These data strongly support the contention that a ratio of 30:2 is superior to 15:2 during manual CPR and that the ITD further enhances circulation with both C:V ratios.

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KW - Cardiopulmonary resuscitation

KW - Hemodynamics

KW - Impedance threshold device

KW - Perfusion

KW - Ventilation

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