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Exploration of strategies to reduce aerosol-spread during chest compressions: A simulation and cadaver model.

ABSTRACT: OBJECTIVE:To evaluate the effect of strategies to reduce the spread of simulated aerosol during chest compressions on manikin and cadaver experimental models. METHODS:To evaluate aerosol-spread we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a further approach we applied nebulized detergents into the airways of human cadavers and detected the simulated spread on the same way. Among others we did recordings with undergoing compression-only-CPR, with a surgical mask or an oxygen mask on the patients face and with an inserted supraglottic airway device with and without a connected airway filter. RESULTS:Most aerosol-spread at the direction of the provider was visualized during compression-only-CPR. The use of a surgical mask and of an oxygen mask on the patient's face deflected the spread. Inserting a supraglottic airway device connected to an airway filter lead to a remarkable reduction of aerosol-spread. CONCLUSION:The early insertion of a supraglottic airway device connected to an airway filter before starting chest compression may be beneficial for staff protection during CPR.

SUBMITTER: Ott M

PROVIDER: S-EPMC7211624 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Exploration of strategies to reduce aerosol-spread during chest compressions: A simulation and cadaver model.

Ott Matthias M Milazzo Alfio A Liebau Stefan S Jaki Christina C Schilling Tobias T Krohn Alexander A Heymer Johannes J

Resuscitation 20200511

<h4>Objective</h4>To evaluate the effect of strategies to reduce the spread of simulated aerosol during chest compressions on manikin and cadaver experimental models.<h4>Methods</h4>To evaluate aerosol-spread we nebulized ultraviolet sensitive detergents into the artificial airway of a resuscitation dummy and performed CPR. The spread of the visualized aerosol was documented by a camera. In a further approach we applied nebulized detergents into the airways of human cadavers and detected the sim ...[more]

PMID: 32437780

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Project description:BackgroundPrevious studies have stated that hyperventilation often occurs in cardiopulmonary resuscitation (CPR) mainly due to excessive ventilation frequencies, especially when a manual valve bag is used. Transport ventilators may provide mandatory ventilation with predetermined tidal volumes and without the risk of hyperventilation. Nonetheless, interactions between chest compressions and ventilations are likely to occur. We investigated whether transport ventilators can provide adequate alveolar ventilation during continuous chest compression in adult CPR.MethodsA three-period crossover study with three common transport ventilators in a cadaver model of CPR was carried out. The three ventilators 'MEDUMAT Standard²', 'Oxylog 3000 plus', and 'Monnal T60' represent three different interventions, providing volume-controlled continuous mandatory ventilation (VC-CMV) via an endotracheal tube with a tidal volume of 6 mL/kg predicted body weight. Proximal airflow was measured, and the net tidal volume was derived for each respiratory cycle. The deviation from the predetermined tidal volume was calculated and analysed. Several mixed linear models were calculated with the cadaver as a random factor and ventilator, height, sex, crossover period and incremental number of each ventilation within the period as covariates to evaluate differences between ventilators.ResultsOverall median deviation of net tidal volume from predetermined tidal volume was - 21.2 % (IQR: 19.6, range: [- 87.9 %; 25.8 %]) corresponding to a tidal volume of 4.75 mL/kg predicted body weight (IQR: 1.2, range: [0.7; 7.6]). In a mixed linear model, the ventilator model, the crossover period, and the cadaver's height were significant factors for decreased tidal volume. The estimated effects of tidal volume deviation for each ventilator were - 14.5 % [95 %-CI: -22.5; -6.5] (p = 0.0004) for 'Monnal T60', - 30.6 % [95 %-CI: -38.6; -22.6] (p < 0.0001) for 'Oxylog 3000 plus' and - 31.0 % [95 %-CI: -38.9; -23.0] (p < 0.0001) for 'MEDUMAT Standard²'.ConclusionsAll investigated transport ventilators were able to provide alveolar ventilation even though chest compressions considerably decreased tidal volumes. Our results support the concept of using ventilators to avoid excessive ventilatory rates in CPR. This experimental study suggests that healthcare professionals should carefully monitor actual tidal volumes to recognise the occurrence of hypoventilation during continuous chest compressions.

Dataset Information

Exploration of strategies to reduce aerosol-spread during chest compressions: A simulation and cadaver model.

Publications

Exploration of strategies to reduce aerosol-spread during chest compressions: A simulation and cadaver model.

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