Am. J. Respir. Crit. Care Med., Vol 154, No. 5, 11 1996, 1323-1329.
Efficacy of cardiopulmonary resuscitation using intratracheal insufflation
L Brochard, G Boussignac, S Adnot, C Bertrand, D Isabey and A Harf
INSERM U 296, Service de Reanimation Medicale, Hopital Henri Mondor,Creteil, France.
The effects of constant-flow insufflation (CFI) of air in the trachea at
the distal end of a modified endotracheal tube as the sole mode of
ventilation during cardiopulmonary resuscitation (CPR) were studied in
pigs. The ventilatory effect of CFI (15 +/- 2 L/min) generating a positive
pressure of about 10 cm H2O with concomitant chest compression was studied
first. In nine sedated, paralyzed animals disconnected from the ventilator,
CFI alone did not significantly alter the decrease in PaO2 and the rise in
PaCO2 observed during apnea. By contrast, the combination of precordial
compression and CFI (CFI-CPR) maintained arterial blood gases over a 4-min
period at the level obtained during mechanical ventilation. In the second
part of the study, ventricular fibrillation was induced and CFI-CPR was
compared with standard CPR using conventional mechanical ventilation during
two successive 4-min periods, in random order. Ventilatory parameters were
identical in the two situations, whereas hemodynamic parameters were
similar or better with CFI-CPR than with standard CPR. Significant
differences were observed between standard CPR and CFI-CPR for systolic
aortic pressure (72 +/- 22 versus 82 +/- 27 mm Hg, respectively; p <
0.02) and for systolic (322 +/- 216 versus 431 +/- 237 ml/s; p < 0.01)
and mean (116 +/- 106 versus 143 +/- 108 ml/s; p < 0.01) common carotid
blood flows. The ease of use of CFI together with its beneficial
hemodynamic effects suggests that CFI deserves to be investigated further
as a mode of ventilation during CPR.
