Effect of continuous oxygen insufflation on induced-gastric air volume during cardiopulmonary resuscitation in a cadaveric model

Effect of continuous oxygen insufflation on induced-gastric air volume during cardiopulmonary resuscitation in a cadaveric model

Segal N1, Voiglio EJ2, Rerbal D3, Jost D4, Dubien PY3, Lanoe V4, Dhers M3, Tourtier JP4, Plaisance P5, Gueugniaud PY3Resuscitation. 2014 Nov 8;86C:62-66.

Source : 1Univ Paris Diderot, Sorbonne Paris Cité, UMRS 942, AP-HP, Hôpital Lariboisière, Service des Urgences, F-75018, Paris, France. Electronic address: dr.nicolas.segal@gmail.com; 2Université Claude Bernard – Lyon 1, UMR T 9405, Groupement Hospitalier Lyon-Sud, Pôle des Urgences, Unité de Chirurgie d’Urgence,F-69495, Pierre-Bénite, France; 3Université Claude Bernard – Lyon 1, Groupement Hospitalier Edouard Herriot, Pôle des Urgences, SAMU de Lyon, F-69437, Lyon, France; 4Brigade des Sapeurs-Pompiers de Paris, Service Médical d’Urgence, F-75017, Paris, France; 5Univ Paris Diderot, Sorbonne Paris Cité, UMRS 942, AP-HP, Hôpital Lariboisière, Services des Urgences, F-75018, Paris, France.

Abstract : BACKGROUND : The main objective of this study was to compare the volume of gas insufflated in the stomach with continuous external chest compressions plus continuous oxygen insufflation (C-CPR) versus standard-CPR (S-CPR) which alternates external chest compressions and synchronized positive insufflations through a bag-valve-mask with a 30/2 ratio. The secondary objective was to compare upper airway pressures (intratracheal and intramask) generated during continuous oxygen insufflationMATERIAL AND METHODS : Open, prospective, randomized, cross over, comparative, non-inferiority study. CPR was performed for six minutes periods, on seven fresh human corpses, with C- CPR or S-CPR in a random order. Before each CPR period, the stomach was completely emptied through the gastrostomy tube, and then 200mL of air was injected in the stomach to be sure it was not collapsed. The gastric volume was measured at the end of each intervention. Intratracheal and intramask pressures were recorded continuously during C- CPR. Results were provided as mean±standard deviation. Statistical analyses were done with a paired student t test. RESULTS : Induced-gastric inflation was lower with C-CPR (221±130ml) than with S-CPR (5401±2208ml, p=0.001). Throughout C-CPR, no difference was found between the intratracheal and intramask pressures (4.4±1.2; 4.0±0.8 cmH2O respectively, p=0.45). CONCLUSION : This human cadaver study demonstrates that continuous oxygen insufflation induced less gastric inflation than intermittent insufflationduring CPR.