Anesth Analg 2006;103:498
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000227073.07034.D1
LETTER TO THE EDITOR
Over-the-Head CPR
Gavin D. Perkins, MD, MRCP, and
Fang Gao, MD, FRCA
Department of Respiratory and Critical Care Medicine, University of Birmingham, Birmingham, UK, gavin.perkins{at}virgin.net (Perkins)
Department of Anaesthesia and Intensive Care, Heart of England NHS Trust, Birmingham, UK (Gao)
To the Editor:
We read with interest the paper investigating over-the-head cardiopulmonary resuscitation (CPR) as an alternative to standard CPR (1). The study supports our (2) and others (3) findings in demonstrating equivalence for chest compressions. However, the statement that over-the-head CPR delivers superior ventilation is not supported by their data and is misleading.
The authors compared mouth-to-mouth and bag-valve-mask ventilation. The authors defined correct tidal volumes as 400–800 mL. This contrasts with current international guidelines which recommend "tidal volumes of 10 mL/kg (approximately 700–1000 mL) for adult cardiac arrest victims" (4). Experimental studies show that small-volume ( 500 mL) ventilation with room or expired air causes significant hypoxia and hypercapnia compared with larger (1000 mL) tidal volumes (5–7). The ventilations classified as incorrect in their paper may have been correct (i.e., 700–1000 mL) or vice versa. To conclude that over-the-head CPR is superior to standard CPR is erroneous and not proven. It would be interesting to know the average tidal volumes for each technique—data collected by the manikin used in their study.
We are surprised that a professional rescue organization tasked with responding to out-of-hospital cardiac arrests advocates mouth-to-mouth ventilation. As the authors recognize, there are small but significant risks with this practice. Mouth-to-mask ventilation reduces the risk of cross-infection and allows supplemental oxygen insufflation. In our study we evaluated this technique and found no difference in tidal volumes between over-the-head and standard CPR.
In summary, in our opinion, the methodological limitations of this study preclude concluding that over-the-head CPR is superior to standard CPR.
References
- Hupfl M, Duma A, Uray T, et al. Over-the-head cardiopulmonary resuscitation improves efficacy in basic life support performed by professional medical personnel with a single rescuer: a simulation study. Anesth Analg 2005;101:200–5.[Abstract/Free Full Text]
- Perkins GD, Stephenson BT, Smith CM, Gao F. A comparison between over-the-head and standard cardiopulmonary resuscitation. Resuscitation 2004;61:155–61.[Web of Science][Medline]
- Handley AJ, Handley JA. Performing chest compressions in a confined space. Resuscitation 2004;61:55–61.[Web of Science][Medline]
- Handley AJ, Monsieurs KG, Bossaert LL. European Resuscitation Council Guidelines 2000 for Adult Basic Life Support. A statement from the Basic Life Support and Automated External Defibrillation Working Group (1) and approved by the Executive Committee of the European Resuscitation Council. Resuscitation 2001;48:199–205.[Web of Science][Medline]
- Stallinger A, Wenzel V, Oroszy S, et al. The effects of different mouth-to-mouth ventilation tidal volumes on gas exchange during simulated rescue breathing. Anesth Analg 2001;93:1265–9.[Abstract/Free Full Text]
- Dorges V, Ocker H, Hagelberg S, et al. Smaller tidal volumes with room-air are not sufficient to ensure adequate oxygenation during bag-valve-mask ventilation. Resuscitation 2000;44:37–41.[Web of Science][Medline]
- Dorph E, Wik L, Steen PA. Arterial blood gases with 700 ml tidal volumes during out-of-hospital CPR. Resuscitation 2004; 1:23–7.
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P. Nagele and M. Hupfl
Over-the-Head CPR
Anesth. Analg.,
August 1, 2006;
103(2):
498 - 499.
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