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Some points from this narrative review:
- much of the existing literature is based on animal models or small human studies
- successful ventilations per compression pause (“synchronous" ventilation, 30:2, without advanced airway) is unsurprisingly important for neurologically intact survival
- no clear difference in outcomes between “synchronous” vs. “asynchronous” (insufflation without pause in CPR) ventilation
- RR below 6 breaths per min were associated with decreased ROSC, whereas faster RR were not associated with worse outcomes (however, be cautious of breathstacking in pts with asthma/COPD)
- chest rise can be detected with TVs as low as 180 mL which is likely not sufficient for CPR
- the benefit of larger tidal volumes (improved oxygenation, less hypercapnia) may outweigh the perceived costs (gastric insufflation, impact on venous return/CO)
Take home pearls:
- use 2-person BVM to ensure adequate TVs and aim for more than just minimal chest rise
- err on the side of moderately larger TVs rather than smaller and moderately faster RR rather than slower (but be cautious in pts with asthma/COPD)
References
van Eijk JA, Doeleman LC, Loer SA, Koster RW, van Schuppen H, Schober P. Ventilation during cardiopulmonary resuscitation: A narrative review. Resuscitation. 2024;203:110366.