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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
This article has been cited by other articles:
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  P. Nagele and M. Hupfl Over-the-Head CPR Anesth. Analg., August 1, 2006; 103(2): 498 - 499. [Full Text] [PDF]
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