Inducing Barotrauma during CPR

[mycrofft]

We never cater.:rofl:

Good question. Balancing likelihood of harm versus likelihood of efficacy. Hasta be an app for that. (We balance likelihood of degree of harm for the particular patient versus then likelihood of etiology for that patient).
Pint taken.

 

[MrBooger]

So back to the origional question.............Do you guys continuously bag someone when intubated, or keep a 30:2 ratio?

 

[Handsome Robb]

So back to the origional question.............Do you guys continuously bag someone when intubated, or keep a 30:2 ratio?

Bag, well set my vent , at a rate of 10-12 with an advanced airway otherwise it's 30:2.

 

[Brandon O]

So back to the origional question.............Do you guys continuously bag someone when intubated, or keep a 30:2 ratio?

The guidelines say that once an advanced airway is in place, you should provide continuous asynchronous ventilations. Anybody teaching otherwise in a formal setting needs to be slapped with a swordfish.

The question about barotrauma is good, but we usually try to prioritize problems. There are a lot of things we used to do in arrests in order to manage theoretical adverse effects, but they interfered with the stuff that really mattered, so they keep getting cut. That's why modern resuscitation is pretty much all about terrific compressions and electricity; those address the lack of circulation, which is the bottleneck for survival. If we had a 100% rate of ROSC, yet every single patient we brought back had aspiration pneumonia, barotrauma, broken ribs, and psoriasis, I think we'd agree that's great work and much better than the alternative.

It's certainly true that fairly minimal ventilations, if any, are needed for these patients. Pulmonary perfusion is low, systemic demand is low, and we're using (nearly) 100% FiO2. Even for longer arrests I am interested in seeing how the data bears out on methods like the NRB with passive insufflation. (Although I wonder if it might be more effective with a nasal cannula at high flow... that's been shown to provide very good apneic oxygenation, whereas the NRB only introduces gas to the airway from active inhalation -- which you're providing somewhat with compressions, but still.)

I think saying that the "vast, vast majority of sudden arrests are due to MI's" may be a stretch. I've seen a range of numbers but the highest has been a modest majority, and in some cases it's a minority (usually vs. structural problems like cardiomyopathy).

 

[mycrofft]

OK, I should have said "structural deficits including infarcts, WPWS, etc., and excluding penetrating trauma". My sourceh34r: said MI so I passed it on.
Good one.