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research article

Gastric insufflation during cardiopulmonary resuscitation: A study in human cadavers

Savary, Dominique
•
Drennan, Ian R.
•
Badat, Bilal
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January 1, 2020
Resuscitation

Introduction: Bag-valve-mask ventilation is the first-line ventilation method during cardiopulmonary resuscitation (CPR). Risks include excessive volume delivery and gastric insufflation, the latter increasing the risk of pneumonia. The efficacy of ventilation can also be reduced by airway closure. We hypothesized that continuous chest compression (CC) could limit the risk of gastric insufflation compared to the recommended 30:2 interrupted CC strategy. This experimental study was performed in human "Thiel" cadavers to assess the respective impact of discontinuous vs. continuous chest compressions on gastric insufflation and ventilation during CPR. Methods: The 30:2 interrupted CC technique was compared to continuous CC in 5 non-intubated cadavers over a 6 min-period. Flow and Airway Pressure were measured at the mask. A percutaneous gastrostomy allowed measuring the cumulative gastric insufflated volume. Two additional cadavers were equipped with esophageal and gastric catheters instead of the gastrostomy. Results: For the 7 cadavers studied (4 women) median age of death was 79 [74-84] years. After 6 min of CPR, the cumulative gastric insufflation measured in 5 cadavers was markedly reduced during continuous CC compared to the interrupted CC strategy: (1.0 [0.8-4.1] vs. 5.9 [4.0-5.6] L: p < 0.05) while expired minute ventilation was slightly higher during continuous than interrupted CC (1.9 [1.4 2.8] vs. 1.6 [1.1-2.7] L/min: P<0.05). In 2 additional cadavers, the progressive rise in baseline gastric pressure was lower during continuous CC than interrupted CC (1 and 2 cmH(2)O vs. 12 and 5.8 cmH(2)O). Conclusion: Continuous CC significantly reduces the volume of gas insufflated in the stomach compared to the recommended 30:2 interrupted CC strategy. Ventilation actually delivered to the lung is also slightly increased by the strategy.

  • Details
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Type
research article
DOI
10.1016/j.resuscitation.2019.10.014
Web of Science ID

WOS:000506191200019

Author(s)
Savary, Dominique
Drennan, Ian R.
Badat, Bilal
Grieco, Domenico L.
Piraino, Thomas
Lesimple, Arnaud  
Charbonney, Emmanuel
Fritz, Caroline
Delisle, Stephane
Ouellet, Paul
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Date Issued

2020-01-01

Published in
Resuscitation
Volume

146

Start page

111

End page

117

Subjects

Critical Care Medicine

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Emergency Medicine

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General & Internal Medicine

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cardio pulmonary resuscitation

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chest compression

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gastric insufflation

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esophageal pressure

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interrupted chest compressions

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esophageal sphincter pressure

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small tidal volumes

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basic life-support

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cardiac-arrest

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ventilation

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inflation

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intubation

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survival

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model

Editorial or Peer reviewed

REVIEWED

Written at

EPFL

EPFL units
SV  
Available on Infoscience
March 3, 2020
Use this identifier to reference this record
https://infoscience.epfl.ch/handle/20.500.14299/166910
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