Effect of positive end-expiratory pressure on additional passive ventilation generated by CPR compressions in a porcine model

Levenbrown, Yosef; Hossain, Md Jobayer; Keith, James P.; Burr, Katlyn; Hesek, Anne; Shaffer, Thomas H.

BACKGROUND: Compressions given during cardiopulmonary resuscitation generate small, ineffective passive ventilations through oscillating waves. Positive end-expiratory pressure increases the volume of these passive ventilations; however, its effect on passive ventilation is unknown. Our objective was to determine if increasing positive end-expiratory pressure during cardiopulmonary resuscitation increases passive ventilation generated by compressions to a clinically significant point. This study was conducted on 13 Landrace-Yorkshire pigs. After inducing cardiac arrest with bupivacaine, cardiopulmonary resuscitation was performed with a LUCAS 3.1. During cardiopulmonary resuscitation, pigs were ventilated at a positive end-expiratory pressure of 0, 5, 10, 15, 20 cmH(2)O (randomly determined) for 9 min. Using the NM3 respiratory monitoring device, expired minute ventilation and volumetric capnography were measured. Arterial blood gas was obtained for each positive end-expiratory pressure level to compare the effects of positive end-expiratory pressure on carbon dioxide. RESULTS: Increasing positive end-expiratory pressure from 0 to 20 cmH(2)O increased the mean (SEM) expired minute ventilation from 6.33 (0.04) to 7.33 (0.04) mL/min. With the 5-cmH(2)O incremental increases in positive end-expiratory pressure from 0 to 20 cmH(2)O, volumetric capnography increased from a mean (SEM) of 94.19 (0.78) to 115.18 (0.8) mL/min, except for 15 cmH(2)O, which showed greater carbon dioxide exhalation with volumetric capnography compared with 20 cmH(2)O. PCO(2) declined significantly as positive end-expiratory pressure was increased from 0 to 20 cmH(2)O. CONCLUSIONS: When increasing positive end-expiratory pressure from 0 to 20, the contribution to overall ventilation from gas oscillations generated by the compressions became more significant, and may even lead to hypocapnia, especially when using positive end-expiratory pressures between 15 and 20.