Ultra-low tidal volume ventilation-A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation

Robert Ruemmler; Alexander Ziebart; Christian Moellmann; Andreas Garcia-Bardon; Jens Kamuf; Frances Kuropka; Bastian Duenges; Erik Kristoffer Hartmann

doi:10.1016/j.resuscitation.2018.08.031

Ultra-low tidal volume ventilation-A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation

Resuscitation. 2018 Nov:132:56-62. doi: 10.1016/j.resuscitation.2018.08.031. Epub 2018 Aug 31.

Authors

Robert Ruemmler¹, Alexander Ziebart², Christian Moellmann², Andreas Garcia-Bardon², Jens Kamuf², Frances Kuropka², Bastian Duenges², Erik Kristoffer Hartmann²

Affiliations

¹ Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany. Electronic address: Robert.Ruemmler@email.de.
² Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langebeckstrasse 1, 55116 Mainz, Germany.

PMID: 30176273
DOI: 10.1016/j.resuscitation.2018.08.031

Abstract

Background: The effects of different ventilation strategies during CPR on patient outcomes and lung physiology are still poorly understood. This study compares positive pressure ventilation (IPPV) to passive oxygenation (CPAP) and a novel ultra-low tidal volume ventilation (ULTVV) regimen in an experimental ventricular fibrillation animal model.

Study design: Prospective randomized controlled trial.

Animals: 30 male German landrace pigs (16-20 weeks).

Methods: Ventricular fibrillation was induced in anesthetized and instrumented pigs and the animals were randomized into three groups. Mechanical CPR was initiated and ventilation was either provided by means of standard IPPV (RR: 10/min, V_t: 8-9 ml/kg, F_iO₂: 1,0, PEEP: 5 mbar), CPAP (O₂-Flow: 10 l/min, PEEP: 5 mbar) or ULTVV (RR: 50/min, V_t: 2-3 ml/kg, F_iO₂: 1,0, PEEP: 5 mbar). Guideline-based advanced life support was applied for a maximum of 4 cycles and animals achieving ROSC were monitored for 6 h before terminating the experiment. Ventilation/perfusion ratios were performed via multiple inert gas elimination, blood gas analyses were taken hourly and extended cardiovascular measurements were collected constantly. Brain and lung tissue samples were taken and analysed for proinflammatory cytokine expression.

Results: ULTVV provided sufficient oxygenation and ventilation during CPR while demanding significantly lower respiratory and intrathoracic pressures. V/Q mismatch was significantly decreased and lung injury was mitigated in surviving animals compared to IPPV and CPAP. Additionally, cerebral cytokine expression was dramatically reduced.

Conclusion: Ultra-low-volume ventilation during CPR in a porcine model is feasible and may provide lung-protective benefits as well as neurological outcome improvement due to lower inflammation. Our results warrant further studies and might eventually lead to new therapeutic options in the resuscitation setting.

Keywords: CPR; Circulation; Lung damage; Lung perfusion; Oxygenation; Ventilation.

Publication types

Comparative Study

MeSH terms

Advanced Cardiac Life Support* / methods
Analysis of Variance
Animals
Continuous Positive Airway Pressure* / methods
Disease Models, Animal
Intermittent Positive-Pressure Ventilation* / methods
Lung Injury / prevention & control
Male
Pulmonary Gas Exchange / physiology
Random Allocation
Real-Time Polymerase Chain Reaction
Swine
Tidal Volume / physiology
Treatment Outcome