Shock. 2022 Aug 1;58(2):119-127. doi: 10.1097/SHK.0000000000001880.
Background: Optimal ventilation during cardio-pulmonary resuscitation (CPR) is still controversial. Ventilation is expected to provide sufficient arterial oxygen content and adequate carbon dioxide removal, while minimizing the risk of circulatory impairment. The objective of the present study was to compare three ventilation strategies in a porcine model during mechanical continuous chest compressions (CCC) according to arterial oxygenation and hemodynamic impact. Method: Ventricular fibrillation was induced and followed by five no-flow minutes and thirty low-flow minutes resuscitation with mechanical-CCC without vasopressive drugs administration. Three groups of eight Landras pig were randomized according to the ventilation strategy: 1. Standard nonsynchronized volume-control mode (SD-group); 2. synchronized bilevel pressure-controlled ventilation (CPV-group); 3. continuous insufflation with Boussignac Cardiac-Arrest Device (BC-group). We assessed 1. arterial blood gases, 2. macro hemodynamics, 3. tissular cerebral macro and micro-circulation and 4. airway pressure, minute ventilation at baseline and every 5 minutes during the protocol. Results: Arterial PaO2 level was higher at each measurement time in SD-group (>200 mm Hg) compare to CPV-group and BC-group ( P < 0.01). In BC-group, arterial PaCO2 level was significantly higher (>90mm Hg) than in SD and CPV groups ( P < 0.01). There was no difference between groups concerning hemodynamic parameters, cerebral perfusion and microcirculation. Conclusion: Ventilation modalities in this porcine model of prolonged CPR influence oxygenation and decarboxylation without impairing circulation and cerebral perfusion. Synchronized bi-level pressure-controlled ventilation' use avoid hyperoxia and was as efficient as asynchronized volume ventilation to maintain alveolar ventilation and systemic perfusion during prolonged CPR.
心肺复苏（CPR）期间的最佳通气仍存在争议。通气旨在提供足够的动脉血氧含量和充分的二氧化碳去除，同时将循环损伤的风险降至最低。本研究的目的是在机械性连续胸部按压（CCC）期间，根据动脉氧合和血液动力学影响，比较三种通气策略在猪模型中的作用。
诱导心室颤动，随后进行 5 分钟无血流和 30 分钟低血流复苏，机械性 CCC 无血管加压药物治疗。根据通气策略将 8 头 Landras 猪随机分为三组：1. 标准非同步容量控制模式（SD 组）；2. 同步双水平压力控制通气（CPV 组）；3. Boussignac 心脏骤停装置（BC 组）持续吹入。我们评估了 1. 动脉血气，2. 宏观血液动力学，3. 组织脑宏观和微循环，4. 气道压力，在方案的每个 5 分钟测量时间测量基础值和通气量。
与 CPV 组和 BC 组相比，SD 组在每个测量时间的动脉 PaO2 水平均较高（>200mmHg）（P <0.01）。BC 组的动脉 PaCO2 水平明显高于 SD 组和 CPV 组（>90mmHg）（P <0.01）。各组之间的血液动力学参数、脑灌注和微循环无差异。
在这种长时间 CPR 的猪模型中，通气方式影响氧合和脱羧作用，而不会损害循环和脑灌注。同步双水平压力控制通气可避免过度通气，与非同步容量通气一样，可在长时间 CPR 期间维持肺泡通气和全身灌注。
