Ventilation during resuscitation

Ventilation during cardiopulmonary resuscitation is a key element of emergency medicine and directly influences patient outcomes. For professional emergency responders, the question is not so much whether to ventilate, but rather how to ensure that ventilation during cardiopulmonary resuscitation under high‑stress conditions is safe, guideline‑compliant, and resource-efficient. WEINMANN ventilators used in emergency medical services can provide critical support here and help minimize sources of error.

Why ventilation during cardiopulmonary resuscitation is essential in emergency medicine

Cardiopulmonary resuscitation without ventilation is incomplete. Although chest compressions alone enable oxygen-rich blood to circulate, they cannot replace structured emergency ventilation, which supplies the body with fresh oxygen and ensures the removal of carbon dioxide. 

For professional users in emergency medical services, in air rescue, disaster response, and hospital environments, ventilation is therefore an integral part of any resuscitation measures, whenever conditions permit.

Objectives of ventilation during cardiopulmonary resuscitation

Ventilation during cardiopulmonary resuscitation has several medical objectives:

• Oxygenation and protection of vital organs: The primary objective of ventilation is oxygenation, i.e., supplying the body with sufficient oxygen to ensure adequate blood flow to vital organs such as the heart and brain. : The primary objective of ventilation is oxygenation - supplying the body with sufficient oxygen to guarantee adequate blood flow to vital organs such as the heart and brain. 
• Ventilation and prevention of hypercapnia: In addition to supplying oxygen, ventilation also serves to exchange oxygen and carbon dioxide (decarboxylation). This is crucial in order to prevent a build-up of carbon dioxide (hypercapnia), which may result in respiratory acidosis.
• Supporting circulation: Ideally, ventilation supports circulation by being performed in synchrony with chest compressions. This can have a positive effect on hemodynamics and improve the overall effectiveness of CPR.

How does ventilation in children differ from ventilation in adults?

Adults are usually resuscitated at a ratio of 30:2, i.e., 30 chest compressions followed by 2 rescue breaths.[1] In children, especially infants and small children, ventilation is much more sensitive and requires even more precise adjustment.

The biggest differences include:

• Significantly smaller lung volumes compared to adults
• Increased sensitivity to excessive ventilation pressures
• Higher oxygen demand per kilogram of body weight
  (6–7 ml/kg/min compared to 3–4 ml/kg/min in adults)[2]
• Greater impact of minor leakage in the respiratory system

The ventilation must therefore be consistently adjusted to height and body weight. Inaccurate estimates or adult settings may otherwise lead to volutrauma, barotrauma or inadequate ventilation.

The MEDUMAT Standard² ventilator from WEINMANN is suitable for children from 3 kg and enables safe ventilation settings by entering patient height.

Ventilation during cardiopulmonary resuscitation of children and infants

For pediatric resuscitation, follow these cardiopulmonary resuscitation (CPR) guidelines:³ 

This is how WEINMANN supports ventilation during resuscitation

WEINMANN improves the efficiency of ventilation during resuscitation with an unsecured airway by using the MEDUtrigger. This function is available with MEDUMAT Easy CPR, MEDUVENT Standard and MEDUMAT Standard² devices.

The MEDUtrigger gives the user flexibility when initiating individual mechanical breaths. A longer press on the trigger activates two guideline-compliant mechanical breaths with a maximum duration of five seconds. Unlike bag-valve-mask ventilation, the user is not dependent on a second person to maintain a mask seal. They can seal the mask with their hands while a ventilator performs the ventilation.

Once the airway has been secured, CCSV mode from WEINMANN offers effective respiratory support. This mode synchronously delivers a short mechanical breath for every chest compression. It is synchronized with the compressions, which means that a chest compression rate of 100/min, for instance, is accompanied by a corresponding ventilation rate. CCSV mode has a number of advantages:

• Improved hemodynamics: In comparison with other ventilation modes, resuscitation with CCSV demonstrates improved oxygenation, a normal venous pH value and a significantly higher median arterial blood pressure, which indicates improved hemodynamics.
• Improved alveolar ventilation: CCSV can prevent hypercapnia and thus counteract respiratory acidosis.
• Improved cerebral oxygenation: CCSV contributes to an increase in cerebral oxygenation during resuscitation.
• More precise ventilation: CCSV works with the preset ventilation values without exceeding the set ventilation pressure during resuscitation.

In this way, CCSV mode from WEINMANN supports reliable ventilation during resuscitation.

¹ https://www.grc-org.de/files/Contentpages/document/Leitlinienkompakt_26.04.2022.pdf

² Neth MR, Benoit JL, Stolz U, McMullan J. Ventilation in Simulated Out-of-Hospital Cardiac Arrest Resuscitation Rarely Meets Guidelines. Prehosp Emerg Care. 2021 Sep-Oct;25(5):712-720. doi: 10.1080/10903127.2020.1822481. Epub 2020 Oct 6. PMID: 33021857.

³ Idris AH, Aramendi Ecenarro E, Leroux B, Jaureguibeitia X, Yang BY, Shaver S, Chang MP, Rea T, Kudenchuk P, Christenson J, Vaillancourt C, Callaway C, Salcido D, Carson J, Blackwood J, Wang HE. Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023 Dec 5;148(23):1847-1856. doi: 10.1161/CIRCULATIONAHA.123.065561. Epub 2023 Nov 12. PMID: 37952192.

⁴ Skrifvars MB, Olasveengen TM, Ristagno G. Oxygen and carbon dioxide targets during and after resuscitation of cardiac arrest patients. Intensive Care Med. 2019 Feb;45(2):284-286. doi: 10.1007/s00134-018-5456-6. Epub 2018 Nov 12. PMID: 30421258.

⁵ Idris AH, Aramendi Ecenarro E, Leroux B, Jaureguibeitia X, Yang BY, Shaver S, Chang MP, Rea T, Kudenchuk P, Christenson J, Vaillancourt C, Callaway C, Salcido D, Carson 

⁶ Larsen R. Kardiopulmonale Reanimation. Anästhesie und Intensivmedizin für die Fachpflege. 2016 Jun 14:627–44. German. doi: 10.1007/978-3-662-50444-4_46. PMCID: PMC7531326.

⁷ Kardiopulmonale Reanimation bei Erwachsenen Von Shira A. Schlesinger , MD, MPH, Harbor-UCLA Medical Center