The Ohio State University, United States.
University of the Basque Country, Spain.
Resuscitation. 2022 Jul;176:80-87. doi: 10.1016/j.resuscitation.2022.05.008. Epub 2022 May 18.
We sought to describe ventilation rates during out-of-hospital cardiac arrest (OHCA) resuscitation and their associations with airway management strategy and outcomes.
We analyzed continuous end-tidal carbon dioxide capnography data from adult OHCA enrolled in the Pragmatic Airway Resuscitation Trial (PART). Using automated signal processing techniques, we determined continuous ventilation rates for consecutive 10-second epochs after airway insertion. We defined hypoventilation as a ventilation rate < 6 breaths/min. We defined hyperventilation as a ventilation rate > 12 breaths/min. We compared differences in total and percentage post-airway hyper- and hypoventilation between airway interventions (laryngeal tube (LT) vs. endotracheal intubation (ETI)). We also determined associations between hypo-/hyperventilation and OHCA outcomes (ROSC, 72-hour survival, hospital survival, hospital survival with favorable neurologic status).
Adequate post-airway capnography were available for 1,010 (LT n = 714, ETI n = 296) of 3,004 patients. Median ventilation rates were: LT 8.0 (IQR 6.5-9.6) breaths/min, ETI 7.9 (6.5-9.7) breaths/min. Total duration and percentage of post-airway time with hypoventilation were similar between LT and ETI: median 1.8 vs. 1.7 minutes, p = 0.94; median 10.5% vs. 11.5%, p = 0.60. Total duration and percentage of post-airway time with hyperventilation were similar between LT and ETI: median 0.4 vs. 0.4 minutes, p = 0.91; median 2.1% vs. 1.9%, p = 0.99. Hypo- and hyperventilation exhibited limited associations with OHCA outcomes.
In the PART Trial, EMS personnel delivered post-airway ventilations at rates satisfying international guidelines, with only limited hypo- or hyperventilation. Hypo- and hyperventilation durations did not differ between airway management strategy and exhibited uncertain associations with OCHA outcomes.
我们旨在描述院外心脏骤停（OHCA）复苏期间的通气率及其与气道管理策略和结局的关系。
我们分析了 Pragmatic Airway Resuscitation Trial（PART）中纳入的成年 OHCA 连续呼气末二氧化碳监测数据。使用自动化信号处理技术，我们确定了气道插入后连续 10 秒的通气率。我们将通气率<6 次/分钟定义为通气不足，通气率>12 次/分钟定义为通气过度。我们比较了气道干预（喉管（LT）与气管内插管（ETI））之间总通气过度和过度通气的差异百分比。我们还确定了通气不足/过度通气与 OHCA 结局（ROSC、72 小时生存率、住院生存率、住院生存率和良好神经状态）之间的关系。
3004 例患者中，1010 例（LT n=714，ETI n=296）有足够的气道后二氧化碳监测数据。通气率中位数分别为：LT 8.0（IQR 6.5-9.6）次/分钟，ETI 7.9（6.5-9.7）次/分钟。LT 和 ETI 之间气道后时间的总持续时间和低通气百分比相似：中位数 1.8 分钟比 1.7 分钟，p=0.94；中位数 10.5%比 11.5%，p=0.60。LT 和 ETI 之间气道后时间的总持续时间和高通气百分比相似：中位数 0.4 分钟比 0.4 分钟，p=0.91；中位数 2.1%比 1.9%，p=0.99。通气不足和过度通气与 OHCA 结局仅有有限的关联。
在 PART 试验中，EMS 人员提供的气道后通气率符合国际指南，只有有限的通气不足或过度通气。气道管理策略之间的通气不足和过度通气持续时间没有差异，与 OHCA 结局的关联不确定。
