Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest

Keith G. Lurie, Demetris Yannopoulos, Scott H. McKnite, Margot L. Herman, Ahamed H. Idris, Vinay M. Nadkarni, Wanchun Tang, Andrea Gabrielli, Thomas A. Barnes, Anja K. Metzger

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

BACKGROUND: Hyperventilation during cardiopulmonary resuscitation (CPR) is harmful. METHODS: We tested the hypotheses that, during CPR, 2 breaths/min would result in higher cerebral perfusion pressure and brain-tissue oxygen tension than 10 breaths/min, and an impedance threshold device (known to increase circulation) would further enhance cerebral perfusion and brain-tissue oxygen tension, especially with 2 breaths/min. RESULTS: Female pigs (30.4 ± 1.3 kg) anesthetized with propofol were subjected to 6 min of untreated ventricular fibrillation, followed by 5 min of CPR (100 compressions/min, compression depth of 25% of the anterior-posterior chest diameter), and ventilated with either 10 breaths/min or 2 breaths/min, while receiving 100% oxygen and a tidal volume of 12 mL/kg. Brain-tissue oxygen tension was measured with a probe in the parietal lobe. The impedance threshold device was then used during an 5 additional min of CPR. During CPR the mean ± SD calculated coronary and cerebral perfusion pressures with 10 breaths/min versus 2 breaths/min, respectively, were 17.6 ± 9.3 mm Hg versus 14.3 ± 6.5 mm Hg (p = 0.20) and 16.0 ± 9.5 mm Hg versus 9.3 ± 12.5 mm Hg (p = 0.25). Carotid artery blood flow, which was prospectively designated as the primary end point, was 65.0 ± 49.6 mL/min in the 10-breaths/min group, versus 34.0 ± 17.1 mL/min in the 2-breaths/min group (p = 0.037). Brain-tissue oxygen tension was 3.0 ± 3.3 mm Hg in the 10-breaths/min group, versus 0.5 ± 0.5 mm Hg in the 2-breaths/min group (p = 0.036). After 5 min of CPR there were no significant differences in arterial pH, PO2, or PCO2 between the groups. During CPR with the impedance threshold device, the mean carotid blood flow and brain-tissue oxygen tension in the 10-breaths/min group and the 2-breaths/min group, respectively, were 102.5 ± 67.9 mm Hg versus 38.8 ± 23.7 mm Hg (p = 0.006) and 4.5 ± 6.0 mm Hg versus 0.7 ± 0.7 mm Hg (p = 0.032). CONCLUSIONS: Contrary to our initial hypothesis, during the first 5 min of CPR, 2 breaths/min resulted in significantly lower carotid blood flow and brain-tissue oxygen tension than did 10 breaths/min. Subsequent addition of an impedance threshold device significantly enhanced carotid flow and brain-tissue oxygen tension, especially in the 10-breaths/min group.

Original languageEnglish (US)
Pages (from-to)862-870
Number of pages9
JournalRespiratory Care
Volume53
Issue number7
StatePublished - Jul 2008

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Cardiopulmonary Resuscitation
Heart Arrest
Swine
Oxygen
Electric Impedance
Brain
Cerebrovascular Circulation
Equipment and Supplies
Parietal Lobe
Hyperventilation
Tidal Volume
Ventricular Fibrillation
Propofol
Carotid Arteries
Thorax
Perfusion

Keywords

  • Brain-tissue oxygenation
  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Cerebral perfusion pressure
  • Circulation
  • CPR
  • Hyperventilation
  • Impedance threshold device
  • Respiration

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Lurie, K. G., Yannopoulos, D., McKnite, S. H., Herman, M. L., Idris, A. H., Nadkarni, V. M., ... Metzger, A. K. (2008). Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Respiratory Care, 53(7), 862-870.

Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest. / Lurie, Keith G.; Yannopoulos, Demetris; McKnite, Scott H.; Herman, Margot L.; Idris, Ahamed H.; Nadkarni, Vinay M.; Tang, Wanchun; Gabrielli, Andrea; Barnes, Thomas A.; Metzger, Anja K.

In: Respiratory Care, Vol. 53, No. 7, 07.2008, p. 862-870.

Research output: Contribution to journalArticle

Lurie, KG, Yannopoulos, D, McKnite, SH, Herman, ML, Idris, AH, Nadkarni, VM, Tang, W, Gabrielli, A, Barnes, TA & Metzger, AK 2008, 'Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest', Respiratory Care, vol. 53, no. 7, pp. 862-870.
Lurie, Keith G. ; Yannopoulos, Demetris ; McKnite, Scott H. ; Herman, Margot L. ; Idris, Ahamed H. ; Nadkarni, Vinay M. ; Tang, Wanchun ; Gabrielli, Andrea ; Barnes, Thomas A. ; Metzger, Anja K. / Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest. In: Respiratory Care. 2008 ; Vol. 53, No. 7. pp. 862-870.
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abstract = "BACKGROUND: Hyperventilation during cardiopulmonary resuscitation (CPR) is harmful. METHODS: We tested the hypotheses that, during CPR, 2 breaths/min would result in higher cerebral perfusion pressure and brain-tissue oxygen tension than 10 breaths/min, and an impedance threshold device (known to increase circulation) would further enhance cerebral perfusion and brain-tissue oxygen tension, especially with 2 breaths/min. RESULTS: Female pigs (30.4 ± 1.3 kg) anesthetized with propofol were subjected to 6 min of untreated ventricular fibrillation, followed by 5 min of CPR (100 compressions/min, compression depth of 25{\%} of the anterior-posterior chest diameter), and ventilated with either 10 breaths/min or 2 breaths/min, while receiving 100{\%} oxygen and a tidal volume of 12 mL/kg. Brain-tissue oxygen tension was measured with a probe in the parietal lobe. The impedance threshold device was then used during an 5 additional min of CPR. During CPR the mean ± SD calculated coronary and cerebral perfusion pressures with 10 breaths/min versus 2 breaths/min, respectively, were 17.6 ± 9.3 mm Hg versus 14.3 ± 6.5 mm Hg (p = 0.20) and 16.0 ± 9.5 mm Hg versus 9.3 ± 12.5 mm Hg (p = 0.25). Carotid artery blood flow, which was prospectively designated as the primary end point, was 65.0 ± 49.6 mL/min in the 10-breaths/min group, versus 34.0 ± 17.1 mL/min in the 2-breaths/min group (p = 0.037). Brain-tissue oxygen tension was 3.0 ± 3.3 mm Hg in the 10-breaths/min group, versus 0.5 ± 0.5 mm Hg in the 2-breaths/min group (p = 0.036). After 5 min of CPR there were no significant differences in arterial pH, PO2, or PCO2 between the groups. During CPR with the impedance threshold device, the mean carotid blood flow and brain-tissue oxygen tension in the 10-breaths/min group and the 2-breaths/min group, respectively, were 102.5 ± 67.9 mm Hg versus 38.8 ± 23.7 mm Hg (p = 0.006) and 4.5 ± 6.0 mm Hg versus 0.7 ± 0.7 mm Hg (p = 0.032). CONCLUSIONS: Contrary to our initial hypothesis, during the first 5 min of CPR, 2 breaths/min resulted in significantly lower carotid blood flow and brain-tissue oxygen tension than did 10 breaths/min. Subsequent addition of an impedance threshold device significantly enhanced carotid flow and brain-tissue oxygen tension, especially in the 10-breaths/min group.",
keywords = "Brain-tissue oxygenation, Cardiac arrest, Cardiopulmonary resuscitation, Cerebral perfusion pressure, Circulation, CPR, Hyperventilation, Impedance threshold device, Respiration",
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TY - JOUR

T1 - Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest

AU - Lurie, Keith G.

AU - Yannopoulos, Demetris

AU - McKnite, Scott H.

AU - Herman, Margot L.

AU - Idris, Ahamed H.

AU - Nadkarni, Vinay M.

AU - Tang, Wanchun

AU - Gabrielli, Andrea

AU - Barnes, Thomas A.

AU - Metzger, Anja K.

PY - 2008/7

Y1 - 2008/7

N2 - BACKGROUND: Hyperventilation during cardiopulmonary resuscitation (CPR) is harmful. METHODS: We tested the hypotheses that, during CPR, 2 breaths/min would result in higher cerebral perfusion pressure and brain-tissue oxygen tension than 10 breaths/min, and an impedance threshold device (known to increase circulation) would further enhance cerebral perfusion and brain-tissue oxygen tension, especially with 2 breaths/min. RESULTS: Female pigs (30.4 ± 1.3 kg) anesthetized with propofol were subjected to 6 min of untreated ventricular fibrillation, followed by 5 min of CPR (100 compressions/min, compression depth of 25% of the anterior-posterior chest diameter), and ventilated with either 10 breaths/min or 2 breaths/min, while receiving 100% oxygen and a tidal volume of 12 mL/kg. Brain-tissue oxygen tension was measured with a probe in the parietal lobe. The impedance threshold device was then used during an 5 additional min of CPR. During CPR the mean ± SD calculated coronary and cerebral perfusion pressures with 10 breaths/min versus 2 breaths/min, respectively, were 17.6 ± 9.3 mm Hg versus 14.3 ± 6.5 mm Hg (p = 0.20) and 16.0 ± 9.5 mm Hg versus 9.3 ± 12.5 mm Hg (p = 0.25). Carotid artery blood flow, which was prospectively designated as the primary end point, was 65.0 ± 49.6 mL/min in the 10-breaths/min group, versus 34.0 ± 17.1 mL/min in the 2-breaths/min group (p = 0.037). Brain-tissue oxygen tension was 3.0 ± 3.3 mm Hg in the 10-breaths/min group, versus 0.5 ± 0.5 mm Hg in the 2-breaths/min group (p = 0.036). After 5 min of CPR there were no significant differences in arterial pH, PO2, or PCO2 between the groups. During CPR with the impedance threshold device, the mean carotid blood flow and brain-tissue oxygen tension in the 10-breaths/min group and the 2-breaths/min group, respectively, were 102.5 ± 67.9 mm Hg versus 38.8 ± 23.7 mm Hg (p = 0.006) and 4.5 ± 6.0 mm Hg versus 0.7 ± 0.7 mm Hg (p = 0.032). CONCLUSIONS: Contrary to our initial hypothesis, during the first 5 min of CPR, 2 breaths/min resulted in significantly lower carotid blood flow and brain-tissue oxygen tension than did 10 breaths/min. Subsequent addition of an impedance threshold device significantly enhanced carotid flow and brain-tissue oxygen tension, especially in the 10-breaths/min group.

AB - BACKGROUND: Hyperventilation during cardiopulmonary resuscitation (CPR) is harmful. METHODS: We tested the hypotheses that, during CPR, 2 breaths/min would result in higher cerebral perfusion pressure and brain-tissue oxygen tension than 10 breaths/min, and an impedance threshold device (known to increase circulation) would further enhance cerebral perfusion and brain-tissue oxygen tension, especially with 2 breaths/min. RESULTS: Female pigs (30.4 ± 1.3 kg) anesthetized with propofol were subjected to 6 min of untreated ventricular fibrillation, followed by 5 min of CPR (100 compressions/min, compression depth of 25% of the anterior-posterior chest diameter), and ventilated with either 10 breaths/min or 2 breaths/min, while receiving 100% oxygen and a tidal volume of 12 mL/kg. Brain-tissue oxygen tension was measured with a probe in the parietal lobe. The impedance threshold device was then used during an 5 additional min of CPR. During CPR the mean ± SD calculated coronary and cerebral perfusion pressures with 10 breaths/min versus 2 breaths/min, respectively, were 17.6 ± 9.3 mm Hg versus 14.3 ± 6.5 mm Hg (p = 0.20) and 16.0 ± 9.5 mm Hg versus 9.3 ± 12.5 mm Hg (p = 0.25). Carotid artery blood flow, which was prospectively designated as the primary end point, was 65.0 ± 49.6 mL/min in the 10-breaths/min group, versus 34.0 ± 17.1 mL/min in the 2-breaths/min group (p = 0.037). Brain-tissue oxygen tension was 3.0 ± 3.3 mm Hg in the 10-breaths/min group, versus 0.5 ± 0.5 mm Hg in the 2-breaths/min group (p = 0.036). After 5 min of CPR there were no significant differences in arterial pH, PO2, or PCO2 between the groups. During CPR with the impedance threshold device, the mean carotid blood flow and brain-tissue oxygen tension in the 10-breaths/min group and the 2-breaths/min group, respectively, were 102.5 ± 67.9 mm Hg versus 38.8 ± 23.7 mm Hg (p = 0.006) and 4.5 ± 6.0 mm Hg versus 0.7 ± 0.7 mm Hg (p = 0.032). CONCLUSIONS: Contrary to our initial hypothesis, during the first 5 min of CPR, 2 breaths/min resulted in significantly lower carotid blood flow and brain-tissue oxygen tension than did 10 breaths/min. Subsequent addition of an impedance threshold device significantly enhanced carotid flow and brain-tissue oxygen tension, especially in the 10-breaths/min group.

KW - Brain-tissue oxygenation

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Cerebral perfusion pressure

KW - Circulation

KW - CPR

KW - Hyperventilation

KW - Impedance threshold device

KW - Respiration

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M3 - Article

VL - 53

SP - 862

EP - 870

JO - Respiratory Care

JF - Respiratory Care

SN - 0020-1324

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