Speer Tillmann, Dersch Wolfgang, Kleine Björn, Neuhaus Christian, Kill Clemens
Department of Emergency Medicine, Faculty of Medicine, Philipps University, Marburg, Germany.
WEINMANN Emergency Medical Technology GmbH + Co. KG, Hamburg, Germany.
Adv Ther. 2017 Oct;34(10):2333-2344. doi: 10.1007/s12325-017-0615-7. Epub 2017 Oct 5.
Guidelines for resuscitation recommend positive-pressure ventilation with a fixed ventilation rate as provided by an automated transport ventilator during cardiopulmonary resuscitation (CPR) with a secured airway. We investigated the influence of manual chest compressions (CC) on the accuracy of ventilator presets and the quality of CC with intermittent positive-pressure ventilation (IPPV), bilevel ventilation (BiLevel), and the novel ventilation mode chest compression synchronized ventilation (CCSV) in a simulation model.
Ninety paramedics performed continuous CC for 2 min on a modified advanced life support mannequin with a realistic lung model. IPPV, BiLevel, and CCSV were applied in a randomized order. CCSV is a novel type of pressure-controlled ventilation with short insufflations synchronized with CC, which are stopped before decompression begins. The ventilator presets (tolerance range) were IPPV Vt = 450 (400-500) ml, PEEP = 0 hPa, f = 10/min; BiLevel Pinsp = 19 (17.1-20.9) hPa, PEEP = 5 hPa, f = 10/min; CCSV Pinsp = 60 (54-66) hPa, PEEP = 0 hPa, Tinsp = 205 ms, f = CC rate. Preset values were compared with the measured results. Values were defined as correct within a tolerance range. Quality of CC was evaluated using ERC guidelines (depth >50 mm, CC rate 100-120/min).
Median (25th/75th percentiles) IPPV V = 399 (386/411) ml, BiLevel Pinsp = 22.0 (19.7/25.6) hPa, and CCSV Pinsp = 55.2 (52.6/56.7) hPa. Relative frequency of delivering correct ventilation parameters according to ventilation mode: IPPV = 40 (0/100)% vs. BiLevel = 20 (0/100)%, p = 0.37 and vs. CCSV = 71 (50/83)%, p < 0.02. Pinsp was too high in BiLevel = 80 (0/100)% vs. CCSV = 0(0/0)%, p < 0.001. CC depth: IPPV 56 (48/63) mm, BiLevel 57 (48/63) mm, CCSV 60 (52/67) mm; CC rate: IPPV 117 (105/124)/min, BiLevel 116 (107/123)/min, CCSV 117 (107/125)/min.
When compared to IPPV and BiLevel, CCSV works best with preset values, without exceeding the upper pressure preset during simulated CPR. Quality of CC is not negatively affected by any of the ventilation patterns.
Parts of this study were supported by Weinmann Emergency Medical Technology GmbH + Co.KG.
复苏指南建议，在进行心肺复苏（CPR）且气道已固定时，使用自动转运呼吸机以固定的通气频率进行正压通气。我们在模拟模型中研究了手动胸外按压（CC）对呼吸机预设参数准确性以及间歇正压通气（IPPV）、双水平通气（BiLevel）和新型通气模式胸外按压同步通气（CCSV）时胸外按压质量的影响。
90名护理人员在配备逼真肺模型的改良高级生命支持模拟人上持续进行2分钟的胸外按压。IPPV、BiLevel和CCSV按随机顺序应用。CCSV是一种新型的压力控制通气方式，短时间吹气与胸外按压同步，且在减压开始前停止。呼吸机预设参数（耐受范围）为：IPPV潮气量（Vt）=450（400 - 500）毫升，呼气末正压（PEEP）=0厘米水柱，频率（f）=10次/分钟；BiLevel吸气压力（Pinsp）=19（17.1 - 20.9）厘米水柱，PEEP = 5厘米水柱，f = 10次/分钟；CCSV Pinsp = 60（54 - 66）厘米水柱，PEEP = 0厘米水柱，吸气时间（Tinsp）=205毫秒，f =胸外按压频率。将预设值与测量结果进行比较。在耐受范围内的值被定义为正确。使用欧洲复苏委员会（ERC）指南（按压深度>50毫米，胸外按压频率100 - 120次/分钟）评估胸外按压质量。
中位数（第25/75百分位数）IPPV潮气量=399（386/411）毫升，BiLevel吸气压力=22.0（19.7/25.6）厘米水柱，CCSV吸气压力=55.2（52.6/56.7）厘米水柱。根据通气模式输送正确通气参数的相对频率：IPPV为40（0/100）%，BiLevel为20（0/100）%，p = 0.37；与CCSV相比为71（50/83）%，p < 0.02。BiLevel中吸气压力过高的比例为80（0/100）%，而CCSV为0（0/0）%，p < 0.001。胸外按压深度：IPPV为56（48/63）毫米，BiLevel为57（48/63）毫米，CCSV为60（52/67）毫米；胸外按压频率：IPPV为117（105/124）次/分钟，BiLevel为116（107/123）次/分钟，CCSV为117（107/125）次/分钟。
与IPPV和BiLevel相比，CCSV在预设参数方面效果最佳，在模拟心肺复苏过程中不会超过预设的压力上限。任何一种通气模式都不会对胸外按压质量产生负面影响。
本研究部分得到了万曼紧急医疗技术有限公司的支持。
