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There are so many variables to monitor during CPR; speed and depth of compressions, rhythm analysis, etc. But how much attention do you give to the ventilations administered?
The right ventricle (RV) fills secondary to the negative pressure created during spontaneously breathing. However, during CPR we administer positive pressure ventilation (PPV), which increase intra-thoracic pressure thus reducing venous return to the RV, decreasing cardiac output, and coronary filling. PPV also increases intracranial pressure by reducing venous return from the brain.
So our goal for ventilations during cardiac arrest should be to minimize the intra-thoracic pressure (ITP); we can do this by remembering to ventilate "low (tidal volumes) and slow (respiratory rates)"
- Low: Use only one-hand while bagging, this will give the patient 500-600cc per breath. Using two-hands provides ~900-1,000cc per squeeze (more than we normally ventilate patients who have a pulse).
- Slow: Ventilate patients at 8-10 breaths per minute. The less you ventilate the less time the patient spends with positive ITP. Observational studies have demonstrated that providers ventilate too fast during code so the use of a metronome or timing light provides critical feedback.
References
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