Ventilation rate in adults with a tracheal tube during cardiopulmonary resuscitation: A systematic review

Abstract

Aim: The optimal ventilation rate during cardiopulmonary resuscitation (CPR) with a tracheal tube is unknown. We evaluated whether in adults with cardiac arrest and a secure airway (tracheal tube), a ventilation rate of 10min^-1, compared to any other rate during CPR, improves outcomes.

Methods: A systematic review up to 14 July 2016. We included both adult human and animal studies. A GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the quality of evidence for each outcome.

Results: We identified one human observational study with 67 patients and ten animal studies (234 pigs and 30 dogs). All studies carried a high risk of bias. All studies evaluated for return of spontaneous circulation (ROSC). Studies showed no improvement in ROSC with a ventilation rate of 10 min-1 compared to any other rate. The evidence for longer-term outcomes such as survival to discharge and survival with favourable neurological outcome was very limited.

Conclusion: A ventilation rate recommendation of 10 min-1 during adult CPR with a tracheal tube and no pauses for chest compression is a very weak recommendation based on very low quality evidence.

Keywords: Cardiac arrest; Neurological outcome; Outcome; ROSC; Resuscitation; Tracheal tube; Ventilation rate.