The current status of ventilation strategies during cardiopulmonary resuscitation

Both health care professionals and the general public are reluctant to perform mouth-to-mouth ventilation because of the widespread fear of contracting contagious diseases. Although several laboratory studies have shown that both gasping and chest compressions result in significant minute ventilation during cardiopulmonary resuscitation (CPR), these strategies may only be applicable if a rescuer is without equipment and chooses to withhold mouth-to-mouth ventilation. The gold standard for CPR performed by professional rescuers is endotracheal intubation and ventilation with oxygen; this remains the best therapy for both ventilation and prevention of aspiration. The European Resuscitation Council has recently recommended that tidal volume be decreased from between 0.8 and 1.2 L to 0.5 L during basic life support CPR, partly to decrease inspiratory flow rate and airway pressure and, therefore, minimize stomach inflation. This strategy provides reasonable ventilation during CPR while avoiding massive gastric inflation, which in turn may result in life-threatening complications.