NowComment
2-Pane Combined
Comments:
Full Summaries Sorted

Commenting period (July 15, 2023 20:51 – August 16, 2023 00:00) is closed

BLS-14-v1


0 General Document comments
0 Sentence and Paragraph comments
0 Image and Video comments


1 RECOVER 2.0 Worksheet

Paragraph 1 0
No paragraph-level conversations.
Paragraph 1, Sentence 1 0
No sentence-level conversations.

2 QUESTION ID: BLS-14

Paragraph 2 0
No paragraph-level conversations.
Paragraph 2, Sentence 1 0
No sentence-level conversations.

3 PICO Question:
In cats and dogs in CPA (P), does any other ventilation rate (I), as opposed to a ventilation rate of 10 breaths per minute (C), improve ... (O)?

Paragraph 3 0
No paragraph-level conversations.
Paragraph 3, Sentence 1 0
No sentence-level conversations.
Paragraph 3, Sentence 2 0
No sentence-level conversations.

4 Outcomes:
Favorable neurologic outcome, PaCO2, Oxygenation, Surrogate markers of perfusion, Survival to discharge, ROSC

Paragraph 4 0
No paragraph-level conversations.
Paragraph 4, Sentence 1 0
No sentence-level conversations.
Paragraph 4, Sentence 2 0
No sentence-level conversations.

5 Prioritized Outcomes:

Paragraph 5 0
No paragraph-level conversations.
Paragraph 5, Sentence 1 0
No sentence-level conversations.
  1. 6 Favorable neurologic outcome
  2. Paragraph 6 0
    No paragraph-level conversations.
    Paragraph 6, Sentence 1 0
    No sentence-level conversations.
  3. 7 Survival to discharge
  4. Paragraph 7 0
    No paragraph-level conversations.
    Paragraph 7, Sentence 1 0
    No sentence-level conversations.
  5. 8 ROSC
  6. Paragraph 8 0
    No paragraph-level conversations.
    Paragraph 8, Sentence 1 0
    No sentence-level conversations.
  7. 9 Surrogate markers of perfusion
  8. Paragraph 9 0
    No paragraph-level conversations.
    Paragraph 9, Sentence 1 0
    No sentence-level conversations.
  9. 10 PaCO2
  10. Paragraph 10 0
    No paragraph-level conversations.
    Paragraph 10, Sentence 1 0
    No sentence-level conversations.
  11. 11 Oxygenation
  12. Paragraph 11 0
    No paragraph-level conversations.
    Paragraph 11, Sentence 1 0
    No sentence-level conversations.

12 Domain chairs: Steve Epstein, Kate Hopper; final edit by Jamie Burkitt

Paragraph 12 0
No paragraph-level conversations.
Paragraph 12, Sentence 1 0
No sentence-level conversations.

13 Evidence evaluators: Beth Eisenberg, Kate Farrell

Paragraph 13 0
No paragraph-level conversations.
Paragraph 13, Sentence 1 0
No sentence-level conversations.

14 Conflicts of interest: None reported

Paragraph 14 0
No paragraph-level conversations.
Paragraph 14, Sentence 1 0
No sentence-level conversations.

15 Search strategy: See attached document

Paragraph 15 0
No paragraph-level conversations.
Paragraph 15, Sentence 1 0
No sentence-level conversations.

16 Evidence Review:

Paragraph 16 0
No paragraph-level conversations.
Paragraph 16, Sentence 1 0
No sentence-level conversations.

17 Study Design

Paragraph 17 0
No paragraph-level conversations.
Paragraph 17, Sentence 1 0
No sentence-level conversations.

18 Reduced Quality Factors

Paragraph 18 0
No paragraph-level conversations.
Paragraph 18, Sentence 1 0
No sentence-level conversations.

19 0 = no serious, - = serious,

Paragraph 19 0
No paragraph-level conversations.
Paragraph 19, Sentence 1 0
No sentence-level conversations.

20 - - = very serious

Paragraph 20 0
No paragraph-level conversations.
Paragraph 20, Sentence 1 0
No sentence-level conversations.

21 Positive Quality Factors

Paragraph 21 0
No paragraph-level conversations.
Paragraph 21, Sentence 1 0
No sentence-level conversations.

22 0 = none, + = one, ++ = multiple

Paragraph 22 0
No paragraph-level conversations.
Paragraph 22, Sentence 1 0
No sentence-level conversations.

23 Dichotomous Outcome Summary

Paragraph 23 0
No paragraph-level conversations.
Paragraph 23, Sentence 1 0
No sentence-level conversations.

24 Non-Dichotomous Outcome Summary

Paragraph 24 0
No paragraph-level conversations.
Paragraph 24, Sentence 1 0
No sentence-level conversations.

25 Brief description

Paragraph 25 0
No paragraph-level conversations.
Paragraph 25, Sentence 1 0
No sentence-level conversations.

26 Overall Quality

Paragraph 26 0
No paragraph-level conversations.
Paragraph 26, Sentence 1 0
No sentence-level conversations.

27 High, moderate, low,
very low, none

Paragraph 27 0
No paragraph-level conversations.
Paragraph 27, Sentence 1 0
No sentence-level conversations.
Paragraph 27, Sentence 2 0
No sentence-level conversations.

28 No of studies

Paragraph 28 0
No paragraph-level conversations.
Paragraph 28, Sentence 1 0
No sentence-level conversations.

29 Study Type

Paragraph 29 0
No paragraph-level conversations.
Paragraph 29, Sentence 1 0
No sentence-level conversations.

30 RoB

Paragraph 30 0
No paragraph-level conversations.
Paragraph 30, Sentence 1 0
No sentence-level conversations.

31 Indirectness

Paragraph 31 0
No paragraph-level conversations.
Paragraph 31, Sentence 1 0
No sentence-level conversations.

32 Imprecision

Paragraph 32 0
No paragraph-level conversations.
Paragraph 32, Sentence 1 0
No sentence-level conversations.

33 Inconsistency

Paragraph 33 0
No paragraph-level conversations.
Paragraph 33, Sentence 1 0
No sentence-level conversations.

34 Large Effect

Paragraph 34 0
No paragraph-level conversations.
Paragraph 34, Sentence 1 0
No sentence-level conversations.

35 Dose-Response

Paragraph 35 0
No paragraph-level conversations.
Paragraph 35, Sentence 1 0
No sentence-level conversations.

36 Confounder

Paragraph 36 0
No paragraph-level conversations.
Paragraph 36, Sentence 1 0
No sentence-level conversations.

37 # Intervention with Outcome

Paragraph 37 0
No paragraph-level conversations.
Paragraph 37, Sentence 1 0
No sentence-level conversations.

38 # Control with Outcome

Paragraph 38 0
No paragraph-level conversations.
Paragraph 38, Sentence 1 0
No sentence-level conversations.

39 RR (95% CI)

Paragraph 39 0
No paragraph-level conversations.
Paragraph 39, Sentence 1 0
No sentence-level conversations.

40 Outcome: Favorable neurologic outcome

Paragraph 40 0
No paragraph-level conversations.
Paragraph 40, Sentence 1 0
No sentence-level conversations.

41 3

Paragraph 41 0
No paragraph-level conversations.
Paragraph 41, Sentence 1 0
No sentence-level conversations.

42 OBS

Paragraph 42 0
No paragraph-level conversations.
Paragraph 42, Sentence 1 0
No sentence-level conversations.

43 0

Paragraph 43 0
No paragraph-level conversations.
Paragraph 43, Sentence 1 0
No sentence-level conversations.

44 - -

Paragraph 44 0
No paragraph-level conversations.
Paragraph 44, Sentence 1 0
No sentence-level conversations.

45 -

Paragraph 45 0
No paragraph-level conversations.
Paragraph 45, Sentence 1 0
No sentence-level conversations.

46 -

Paragraph 46 0
No paragraph-level conversations.
Paragraph 46, Sentence 1 0
No sentence-level conversations.

47 0

Paragraph 47 0
No paragraph-level conversations.
Paragraph 47, Sentence 1 0
No sentence-level conversations.

48 0

Paragraph 48 0
No paragraph-level conversations.
Paragraph 48, Sentence 1 0
No sentence-level conversations.

49 0

Paragraph 49 0
No paragraph-level conversations.
Paragraph 49, Sentence 1 0
No sentence-level conversations.

50 Two observational studies suggest higher ventilation rates are associated with better neurological outcomes in adult and pediatric human patients. One observational study in adults found no difference with <10bpm vs > 10 bpm

Paragraph 50 0
No paragraph-level conversations.
Paragraph 50, Sentence 1 0
No sentence-level conversations.
Paragraph 50, Sentence 2 0
No sentence-level conversations.

51 Very low

Paragraph 51 0
No paragraph-level conversations.
Paragraph 51, Sentence 1 0
No sentence-level conversations.

52 1

Paragraph 52 0
No paragraph-level conversations.
Paragraph 52, Sentence 1 0
No sentence-level conversations.

53 EX

Paragraph 53 0
No paragraph-level conversations.
Paragraph 53, Sentence 1 0
No sentence-level conversations.

54 0

Paragraph 54 0
No paragraph-level conversations.
Paragraph 54, Sentence 1 0
No sentence-level conversations.

55 -

Paragraph 55 0
No paragraph-level conversations.
Paragraph 55, Sentence 1 0
No sentence-level conversations.

56 -

Paragraph 56 0
No paragraph-level conversations.
Paragraph 56, Sentence 1 0
No sentence-level conversations.

57 0

Paragraph 57 0
No paragraph-level conversations.
Paragraph 57, Sentence 1 0
No sentence-level conversations.

58 0

Paragraph 58 0
No paragraph-level conversations.
Paragraph 58, Sentence 1 0
No sentence-level conversations.

59 0

Paragraph 59 0
No paragraph-level conversations.
Paragraph 59, Sentence 1 0
No sentence-level conversations.

60 0

Paragraph 60 0
No paragraph-level conversations.
Paragraph 60, Sentence 1 0
No sentence-level conversations.

61 In a swine study there was no difference in neurologic outcome when 10 vs 35 breaths per minute were used.

Paragraph 61 0
No paragraph-level conversations.
Paragraph 61, Sentence 1 0
No sentence-level conversations.

62 Very low

Paragraph 62 0
No paragraph-level conversations.
Paragraph 62, Sentence 1 0
No sentence-level conversations.

63 Outcome: Survival to discharge

Paragraph 63 0
No paragraph-level conversations.
Paragraph 63, Sentence 1 0
No sentence-level conversations.

64 2

Paragraph 64 0
No paragraph-level conversations.
Paragraph 64, Sentence 1 0
No sentence-level conversations.

65 OBS

Paragraph 65 0
No paragraph-level conversations.
Paragraph 65, Sentence 1 0
No sentence-level conversations.

66 0

Paragraph 66 0
No paragraph-level conversations.
Paragraph 66, Sentence 1 0
No sentence-level conversations.

67 - -

Paragraph 67 0
No paragraph-level conversations.
Paragraph 67, Sentence 1 0
No sentence-level conversations.

68 -

Paragraph 68 0
No paragraph-level conversations.
Paragraph 68, Sentence 1 0
No sentence-level conversations.

69 -

Paragraph 69 0
No paragraph-level conversations.
Paragraph 69, Sentence 1 0
No sentence-level conversations.

70 0

Paragraph 70 0
No paragraph-level conversations.
Paragraph 70, Sentence 1 0
No sentence-level conversations.

71 0

Paragraph 71 0
No paragraph-level conversations.
Paragraph 71, Sentence 1 0
No sentence-level conversations.

72 0

Paragraph 72 0
No paragraph-level conversations.
Paragraph 72, Sentence 1 0
No sentence-level conversations.

73 One observational study suggested higher ventilation rates were associated with better survival to discharge in pediatric human patients. One observational study in adults found no difference with <10bpm vs > 10 bpm

Paragraph 73 0
No paragraph-level conversations.
Paragraph 73, Sentence 1 0
No sentence-level conversations.
Paragraph 73, Sentence 2 0
No sentence-level conversations.

74 Very low

Paragraph 74 0
No paragraph-level conversations.
Paragraph 74, Sentence 1 0
No sentence-level conversations.

75 1

Paragraph 75 0
No paragraph-level conversations.
Paragraph 75, Sentence 1 0
No sentence-level conversations.

76 EX

Paragraph 76 0
No paragraph-level conversations.
Paragraph 76, Sentence 1 0
No sentence-level conversations.

77 0

Paragraph 77 0
No paragraph-level conversations.
Paragraph 77, Sentence 1 0
No sentence-level conversations.

78 - -

Paragraph 78 0
No paragraph-level conversations.
Paragraph 78, Sentence 1 0
No sentence-level conversations.

79 -

Paragraph 79 0
No paragraph-level conversations.
Paragraph 79, Sentence 1 0
No sentence-level conversations.

80 0

Paragraph 80 0
No paragraph-level conversations.
Paragraph 80, Sentence 1 0
No sentence-level conversations.

81 0

Paragraph 81 0
No paragraph-level conversations.
Paragraph 81, Sentence 1 0
No sentence-level conversations.

82 0

Paragraph 82 0
No paragraph-level conversations.
Paragraph 82, Sentence 1 0
No sentence-level conversations.

83 0

Paragraph 83 0
No paragraph-level conversations.
Paragraph 83, Sentence 1 0
No sentence-level conversations.

84 In a swine study there was no difference in survival to discharge when 10 vs 35 breaths per minute were used

Paragraph 84 0
No paragraph-level conversations.
Paragraph 84, Sentence 1 0
No sentence-level conversations.

85 Very low

Paragraph 85 0
No paragraph-level conversations.
Paragraph 85, Sentence 1 0
No sentence-level conversations.

86 Outcome: ROSC

Paragraph 86 0
No paragraph-level conversations.
Paragraph 86, Sentence 1 0
No sentence-level conversations.

87 2

Paragraph 87 0
No paragraph-level conversations.
Paragraph 87, Sentence 1 0
No sentence-level conversations.

88 OBS

Paragraph 88 0
No paragraph-level conversations.
Paragraph 88, Sentence 1 0
No sentence-level conversations.

89 0

Paragraph 89 0
No paragraph-level conversations.
Paragraph 89, Sentence 1 0
No sentence-level conversations.

90 - -

Paragraph 90 0
No paragraph-level conversations.
Paragraph 90, Sentence 1 0
No sentence-level conversations.

91 -

Paragraph 91 0
No paragraph-level conversations.
Paragraph 91, Sentence 1 0
No sentence-level conversations.

92 -

Paragraph 92 0
No paragraph-level conversations.
Paragraph 92, Sentence 1 0
No sentence-level conversations.

93 0

Paragraph 93 0
No paragraph-level conversations.
Paragraph 93, Sentence 1 0
No sentence-level conversations.

94 0

Paragraph 94 0
No paragraph-level conversations.
Paragraph 94, Sentence 1 0
No sentence-level conversations.

95 0

Paragraph 95 0
No paragraph-level conversations.
Paragraph 95, Sentence 1 0
No sentence-level conversations.

96 One observational study suggested higher ventilation rates were associated with better ROSC in pediatric human patients. One observational study in adults found no difference with <10bpm vs > 10 bpm

Paragraph 96 0
No paragraph-level conversations.
Paragraph 96, Sentence 1 0
No sentence-level conversations.
Paragraph 96, Sentence 2 0
No sentence-level conversations.

97 Very low

Paragraph 97 0
No paragraph-level conversations.
Paragraph 97, Sentence 1 0
No sentence-level conversations.

98 4

Paragraph 98 0
No paragraph-level conversations.
Paragraph 98, Sentence 1 0
No sentence-level conversations.

99 EXP

Paragraph 99 0
No paragraph-level conversations.
Paragraph 99, Sentence 1 0
No sentence-level conversations.

100 0

Paragraph 100 0
No paragraph-level conversations.
Paragraph 100, Sentence 1 0
No sentence-level conversations.

101 -

Paragraph 101 0
No paragraph-level conversations.
Paragraph 101, Sentence 1 0
No sentence-level conversations.

102 -

Paragraph 102 0
No paragraph-level conversations.
Paragraph 102, Sentence 1 0
No sentence-level conversations.

103 -

Paragraph 103 0
No paragraph-level conversations.
Paragraph 103, Sentence 1 0
No sentence-level conversations.

104 0

Paragraph 104 0
No paragraph-level conversations.
Paragraph 104, Sentence 1 0
No sentence-level conversations.

105 0

Paragraph 105 0
No paragraph-level conversations.
Paragraph 105, Sentence 1 0
No sentence-level conversations.

106 0

Paragraph 106 0
No paragraph-level conversations.
Paragraph 106, Sentence 1 0
No sentence-level conversations.

107 3 experimental swine studies comparing ventilation rates of ~10 vs 30bpm found no difference in ROSC. One experiential swine study found higher rates of ROSC with 12bpm compared to 30 bpm

Paragraph 107 0
No paragraph-level conversations.
Paragraph 107, Sentence 1 0
No sentence-level conversations.
Paragraph 107, Sentence 2 0
No sentence-level conversations.

108 Very low

Paragraph 108 0
No paragraph-level conversations.
Paragraph 108, Sentence 1 0
No sentence-level conversations.

109 Outcome: Surrogate markers of perfusion

Paragraph 109 0
No paragraph-level conversations.
Paragraph 109, Sentence 1 0
No sentence-level conversations.

110 1

Paragraph 110 0
No paragraph-level conversations.
Paragraph 110, Sentence 1 0
No sentence-level conversations.

111 OBS

Paragraph 111 0
No paragraph-level conversations.
Paragraph 111, Sentence 1 0
No sentence-level conversations.

112 0

Paragraph 112 0
No paragraph-level conversations.
Paragraph 112, Sentence 1 0
No sentence-level conversations.

113 - -

Paragraph 113 0
No paragraph-level conversations.
Paragraph 113, Sentence 1 0
No sentence-level conversations.

114 -

Paragraph 114 0
No paragraph-level conversations.
Paragraph 114, Sentence 1 0
No sentence-level conversations.

115 0

Paragraph 115 0
No paragraph-level conversations.
Paragraph 115, Sentence 1 0
No sentence-level conversations.

116 0

Paragraph 116 0
No paragraph-level conversations.
Paragraph 116, Sentence 1 0
No sentence-level conversations.

117 0

Paragraph 117 0
No paragraph-level conversations.
Paragraph 117, Sentence 1 0
No sentence-level conversations.

118 0

Paragraph 118 0
No paragraph-level conversations.
Paragraph 118, Sentence 1 0
No sentence-level conversations.

119 One observational study suggested no association between ventilation rates and arterial blood pressure

Paragraph 119 0
No paragraph-level conversations.
Paragraph 119, Sentence 1 0
No sentence-level conversations.

120 in pediatric human patients.

Paragraph 120 0
No paragraph-level conversations.
Paragraph 120, Sentence 1 0
No sentence-level conversations.

121 Very low

Paragraph 121 0
No paragraph-level conversations.
Paragraph 121, Sentence 1 0
No sentence-level conversations.

122 8

Paragraph 122 0
No paragraph-level conversations.
Paragraph 122, Sentence 1 0
No sentence-level conversations.

123 EX

Paragraph 123 0
No paragraph-level conversations.
Paragraph 123, Sentence 1 0
No sentence-level conversations.

124 0

Paragraph 124 0
No paragraph-level conversations.
Paragraph 124, Sentence 1 0
No sentence-level conversations.

125 - -

Paragraph 125 0
No paragraph-level conversations.
Paragraph 125, Sentence 1 0
No sentence-level conversations.

126 -

Paragraph 126 0
No paragraph-level conversations.
Paragraph 126, Sentence 1 0
No sentence-level conversations.

127 -

Paragraph 127 0
No paragraph-level conversations.
Paragraph 127, Sentence 1 0
No sentence-level conversations.

128 0

Paragraph 128 0
No paragraph-level conversations.
Paragraph 128, Sentence 1 0
No sentence-level conversations.

129 0

Paragraph 129 0
No paragraph-level conversations.
Paragraph 129, Sentence 1 0
No sentence-level conversations.

130 0

Paragraph 130 0
No paragraph-level conversations.
Paragraph 130, Sentence 1 0
No sentence-level conversations.

131 Two experimental studies favored lower ventilation rates, one dog study with synchronized ventilation favored higher ventilation rates and 5 studies found no difference with ventilation rate.

Paragraph 131 0
No paragraph-level conversations.
Paragraph 131, Sentence 1 0
No sentence-level conversations.

132 Very low

Paragraph 132 0
No paragraph-level conversations.
Paragraph 132, Sentence 1 0
No sentence-level conversations.

133 Outcome: PaCO2

Paragraph 133 0
No paragraph-level conversations.
Paragraph 133, Sentence 1 0
No sentence-level conversations.

134 4

Paragraph 134 0
No paragraph-level conversations.
Paragraph 134, Sentence 1 0
No sentence-level conversations.

135 EX

Paragraph 135 0
No paragraph-level conversations.
Paragraph 135, Sentence 1 0
No sentence-level conversations.

136 0

Paragraph 136 0
No paragraph-level conversations.
Paragraph 136, Sentence 1 0
No sentence-level conversations.

137 - -

Paragraph 137 0
No paragraph-level conversations.
Paragraph 137, Sentence 1 0
No sentence-level conversations.

138 -

Paragraph 138 0
No paragraph-level conversations.
Paragraph 138, Sentence 1 0
No sentence-level conversations.

139 -

Paragraph 139 0
No paragraph-level conversations.
Paragraph 139, Sentence 1 0
No sentence-level conversations.

140 0

Paragraph 140 0
No paragraph-level conversations.
Paragraph 140, Sentence 1 0
No sentence-level conversations.

141 0

Paragraph 141 0
No paragraph-level conversations.
Paragraph 141, Sentence 1 0
No sentence-level conversations.

142 0

Paragraph 142 0
No paragraph-level conversations.
Paragraph 142, Sentence 1 0
No sentence-level conversations.

143 Of these 4 experimental studies, 2 swine studies of ventilation rate of ~10pbm vs 30bpm, found PaCO2 to higher in the lower ventilation rate group. One swine and canine study found no difference in PaCO2 with differing ventilation rates.

Paragraph 143 0
No paragraph-level conversations.
Paragraph 143, Sentence 1 0
No sentence-level conversations.
Paragraph 143, Sentence 2 0
No sentence-level conversations.

144 Very low

Paragraph 144 0
No paragraph-level conversations.
Paragraph 144, Sentence 1 0
No sentence-level conversations.

145 Outcome: Oxygenation

Paragraph 145 0
No paragraph-level conversations.
Paragraph 145, Sentence 1 0
No sentence-level conversations.

146 5

Paragraph 146 0
No paragraph-level conversations.
Paragraph 146, Sentence 1 0
No sentence-level conversations.

147 EX

Paragraph 147 0
No paragraph-level conversations.
Paragraph 147, Sentence 1 0
No sentence-level conversations.

148 0

Paragraph 148 0
No paragraph-level conversations.
Paragraph 148, Sentence 1 0
No sentence-level conversations.

149 - -

Paragraph 149 0
No paragraph-level conversations.
Paragraph 149, Sentence 1 0
No sentence-level conversations.

150 -

Paragraph 150 0
No paragraph-level conversations.
Paragraph 150, Sentence 1 0
No sentence-level conversations.

151 0

Paragraph 151 0
No paragraph-level conversations.
Paragraph 151, Sentence 1 0
No sentence-level conversations.

152 0

Paragraph 152 0
No paragraph-level conversations.
Paragraph 152, Sentence 1 0
No sentence-level conversations.

153 0

Paragraph 153 0
No paragraph-level conversations.
Paragraph 153, Sentence 1 0
No sentence-level conversations.

154 0

Paragraph 154 0
No paragraph-level conversations.
Paragraph 154, Sentence 1 0
No sentence-level conversations.

155 Five experimental studies (4 swine, 1 canine) found no difference in oxygenation with variable ventilation rates

Paragraph 155 0
No paragraph-level conversations.
Paragraph 155, Sentence 1 0
No sentence-level conversations.

156 Very low

Paragraph 156 0
No paragraph-level conversations.
Paragraph 156, Sentence 1 0
No sentence-level conversations.

157 PICO Question Summary

Paragraph 157 0
No paragraph-level conversations.
Paragraph 157, Sentence 1 0
No sentence-level conversations.

158 Introduction

Paragraph 158 0
No paragraph-level conversations.
Paragraph 158, Sentence 1 0
No sentence-level conversations.

159 Providing rescue breaths during CPR has been shown to improve oxygenation, ventilation, and outcomes, but these benefits must be weighed against the potential negative cardiovascular consequences of positive pressure breaths. Increases in intrathoracic pressure associated with positive pressure breaths can reduce venous return and cardiovascular performance during chest compressions.1 In addition it has long been known that hyperventilation can lead to hypocapnia-associated cerebral vasoconstriction that may worsen neurologic outcomes.2 The current human and previous veterinary CPR guidelines recommend a ventilation rate of 10 breaths per minute.3,4

Paragraph 159 0
No paragraph-level conversations.
Paragraph 159, Sentence 1 0
No sentence-level conversations.
Paragraph 159, Sentence 2 0
No sentence-level conversations.

160 Consensus on science

Paragraph 160 0
No paragraph-level conversations.
Paragraph 160, Sentence 1 0
No sentence-level conversations.

161 Outcome 1: Favorable neurologic outcome

Paragraph 161 0
No paragraph-level conversations.
Paragraph 161, Sentence 1 0
No sentence-level conversations.

162 For the most critical outcome of FNO, we found 3 observational studies in people (very low quality of evidence, downgraded for very serious indirectness, serious imprecision, and serious inconsistency) and 1 experimental study in swine (very low quality of evidence, downgraded for very serious indirectness and serious imprecision) that address the PICO question.5–8 In an observational study directly comparing CPR ventilation rates (mean +/- SD) in 285 adult survivors of OHCA with a better cerebral performance category (CPC) of 1-2 to rates in those with worse CPC of 3-5, CPR ventilation rates had been higher (12.7 +/- 6.1 vs 7.3 ± 3.5 breaths per minute (bpm)) in patients that achieved a better CPC. Additionally, in multivariate analysis, increasing ventilation rate was associated with a favorable neurologic outcome (CPC 1-2 vs 3-5) [OR (95%CI) 3.795 (1.507–9.557)].7 Another study in 337 adults with OHCA compared ventilation rates of < 10 bpm to rates > 10 bpm and found no difference between groups in FNO at 1 year.6 In 18 children experiencing IHCA, a ventilation rate of > 30 bpm in < 1-year-olds or > 25 bpm in 1- to 17-year-olds had an OR (95%CI) of 4.73 (1.17 – 19.13) for FNO compared to lower rates.8 An experimental swine study using a fibrillatory arrest model compared FNO at 24 hours in pigs receiving a ventilation rate of 10 bpm at 10 ml/kg to those receiving a rate of 35 bpm at 20 ml/kg; no difference in FNO was found.5

Paragraph 162 0
No paragraph-level conversations.
Paragraph 162, Sentence 1 0
No sentence-level conversations.
Paragraph 162, Sentence 2 0
No sentence-level conversations.

163 Outcome 2: Survival to discharge

Paragraph 163 0
No paragraph-level conversations.
Paragraph 163, Sentence 1 0
No sentence-level conversations.

164 For the critical outcome of survival to discharge, we found 2 observational studies6,8 (very low quality of evidence, downgraded for very serious indirectness, serious imprecision, and serious inconsistency) and 1 experimental animal trial5 (very low quality of evidence, downgraded for very serious indirectness and serious imprecision) that addressed the PICO question. In 47 children experiencing IHCA, a ventilation rate of > 30 bpm in < 1-year-olds or > 25 bpm in 1- to 17-year-olds had an OR (95%CI) of 4.73 (1.32 - 16.27) for improved survival to discharge compared to patients in whom lower RRs were used.8 Another study in 337 adults with OHCA compared ventilation rates of < 10 bpm to rates > 10 bpm and found no difference between groups in likelihood of survival to discharge.6 An experimental swine study using a fibrillatory arrest model compared survival at 24 hours in pigs receiving a ventilation rate of 10 bpm at 10 ml/kg to those receiving a rate of 35 bpm at 20 ml/kg; no difference in 24-hour survival was found.5

Paragraph 164 0
No paragraph-level conversations.
Paragraph 164, Sentence 1 0
No sentence-level conversations.
Paragraph 164, Sentence 2 0
No sentence-level conversations.

165 Outcome 3: ROSC

Paragraph 165 0
No paragraph-level conversations.
Paragraph 165, Sentence 1 0
No sentence-level conversations.

166 For the critical outcome of ROSC we identified 2 observational studies6,8 (very low quality of evidence, downgraded for very serious indirectness, serious imprecision, and serious inconsistency) and 4 experimental studies5,6,9–11 (very low quality of evidence, downgraded for serious indirectness, serious imprecision, and serious inconsistency) that address the PICO question. One study in 337 adults with OHCA compared ventilation rates of < 10 bpm to rates > 10 bpm and found no difference between groups in likelihood of ROSC.6 In 47 children experiencing 52 events of IHCA, a ventilation rate of > 30 bpm in < 1-year-olds or > 25 bpm in 1- to 17-year-olds had an OR (95%CI) of 4.64 (1.17 – 19.13) for increased incidence of ROSC compared to events in which lower RRs were used.8 An experimental swine study using a fibrillatory arrest model compared ROSC in pigs receiving a ventilation rate of 10 bpm at 10 ml/kg to those receiving a rate of 35 bpm at 20 ml/kg; no difference in ROSC was found.5 In a second swine study of fibrillatory CPA, a RR of 10 vs 33 bpm at tidal volumes of both 6 and 18 ml/kg had no statistical association with ROSC.9 An experimental piglet study of asphyxial arrest compared ventilation rates of 10, 20, and 30 bpm and found no difference in ROSC.10 A final experimental swine study compared CPR using 12 bpm or 30 bpm; ROSC was significantly greater (6/7) in pigs receiving 12 bpm compared to those (1/7) receiving 30 bpm.11

Paragraph 166 0
No paragraph-level conversations.
Paragraph 166, Sentence 1 0
No sentence-level conversations.
Paragraph 166, Sentence 2 0
No sentence-level conversations.

167 Outcome 4: Surrogate markers of perfusion

Paragraph 167 0
No paragraph-level conversations.
Paragraph 167, Sentence 1 0
No sentence-level conversations.

168 For the important outcome of surrogate markers of perfusion, we found 1 observational study8 (very low quality of evidence, downgraded for very serious indirectness and serious imprecision) and 8 experimental animal studies5,8–15 (very low quality of evidence, downgraded for very serious indirectness, serious imprecision, and serious inconsistency) that address the PICO question. In 47 children experiencing 52 events of IHCA, ventilation rate was not associated with arterial blood pressure.8 In an experimental swine study, a respiratory rate of 10 vs 33 bpm at tidal volumes of both 6 and 18 ml/kg was not associated with aortic pressure, right atrial pressure, carotid blood flow, CoPP, or CePP. ETCO2 was lower with higher ventilation rates and tidal volumes.9 A fibrillatory swine study found that a RR of 2 bpm resulted in lower brain oxygen tension, carotid blood flow, right atrial systolic pressure, and intracranial systolic pressure, than did a RR of 10 bpm.15 In a fibrillatory canine model comparing a RR of 10 bpm (not synchronized) with a RR of 30 bpm (synchronized), dogs ventilated at 30 bpm (synchronized) had higher right atrial pressure, higher carotid artery pressure, higher jugular vein pressure, and higher carotid artery-RAP gradient (approximation of CePP). Left carotid artery flow was also significantly higher in the 30bpm (synchronized) group.13 An additional 5 experimental swine studies showed no difference in any surrogate marker of perfusion measured with variable ventilation rates.5,10–12,14

Paragraph 168 0
No paragraph-level conversations.
Paragraph 168, Sentence 1 0
No sentence-level conversations.
Paragraph 168, Sentence 2 0
No sentence-level conversations.
Paragraph 168, Sentence 3 0
No sentence-level conversations.
Paragraph 168, Sentence 4 0
No sentence-level conversations.

169 Outcome 5: PaCO2

Paragraph 169 0
No paragraph-level conversations.
Paragraph 169, Sentence 1 0
No sentence-level conversations.

170 For the important outcome of PaCO2, we found 4 experimental animal studies (very low quality evidence, downgraded for very serious indirectness, serious imprecision, and serious inconsistency) that address the PICO question.5,10,11,13 An experimental swine study of fibrillatory arrest compared ventilation patterns of 10 bpm at 10 ml/kg vs 35 bpm at 20 ml/kg and showed that the 35 bpm group had an inappropriately low PaCO2 while the 10 bpm group had mean PaCO2 in the low 30s.5 An experimental swine study comparing 12 vs 30 bpm showed that the 30 bpm group had a lower PaCO2.11 In an asphyxial arrest model in 1-2-month-old piglets comparing 10 vs 20 vs 30 bpm, no differences in PaCO2 at 3, 8, 18, and 24 minutes of CPR were found.10 In an experimental canine study comparing a RR of 10 bpm (not synchronized) with 30 bpm (synchronized), no difference in PaCO2 at 7 min of CPR was found.13

Paragraph 170 0
No paragraph-level conversations.
Paragraph 170, Sentence 1 0
No sentence-level conversations.

171 Outcome 6: Oxygenation

Paragraph 171 0
No paragraph-level conversations.
Paragraph 171, Sentence 1 0
No sentence-level conversations.

172 For the important outcome of oxygenation, we found 5 experimental studies (very low quality of evidence, downgraded for very serious indirectness and serious imprecision) that address the PICO question.5,9,10,13,14 All 5 experimental studies (4 swine and 1 canine) found no differences in oxygenation with different ventilation rates used. 5,9,10,13,14

Paragraph 172 0
No paragraph-level conversations.
Paragraph 172, Sentence 1 0
No sentence-level conversations.
Paragraph 172, Sentence 2 0
No sentence-level conversations.

173 Treatment recommendation

Paragraph 173 0
No paragraph-level conversations.
Paragraph 173, Sentence 1 0
No sentence-level conversations.

174 In intubated dogs and cats undergoing CPR, we recommend a respiratory rate of 10 breaths per minute.(very low quality of evidence, expert opinion)

Paragraph 174 0
No paragraph-level conversations.
Paragraph 174, Sentence 1 0
No sentence-level conversations.

175 Justification of treatment recommendation

Paragraph 175 0
No paragraph-level conversations.
Paragraph 175, Sentence 1 0
No sentence-level conversations.

176 For the outcome of survival to discharge and favorable neurological outcome, there are mixed findings. The studies suggesting a benefit of higher ventilation rates were all of a very low quality for our population. However, for the outcomes of ROSC, surrogate markers of perfusion, and PaCO2, a preponderance of the evidence supports the use of lower ventilation rates. The committee selected a breathing rate of 10 per minute to maintain consistency for the purpose of ETCO2 monitoring and for ease of rescuer performance.

Paragraph 176 0
No paragraph-level conversations.
Paragraph 176, Sentence 1 0
No sentence-level conversations.
Paragraph 176, Sentence 2 0
No sentence-level conversations.
Paragraph 176, Sentence 3 0
No sentence-level conversations.
Paragraph 176, Sentence 4 0
No sentence-level conversations.

177 Knowledge gaps

Paragraph 177 0
No paragraph-level conversations.
Paragraph 177, Sentence 1 0
No sentence-level conversations.

178 Effect of ventilation rate during CPR in clinical trials in any species is lacking. Drawing conclusions from experimental studies, even the one study performed in dogs, is difficult because of the nature of the arrest and the methods of CPR. Additional studies without the use of an impedance threshold device would be beneficial.

Paragraph 178 0
No paragraph-level conversations.
Paragraph 178, Sentence 1 0
No sentence-level conversations.
Paragraph 178, Sentence 2 0
No sentence-level conversations.
Paragraph 178, Sentence 3 0
No sentence-level conversations.

179 References:

Paragraph 179 0
No paragraph-level conversations.
Paragraph 179, Sentence 1 0
No sentence-level conversations.

180 1. Corp A, Thomas C, Adlam M. The cardiovascular effects of positive pressure ventilation. BJA Educ. 2021;21(6):202-209.

Paragraph 180 0
No paragraph-level conversations.
Paragraph 180, Sentence 1 0
No sentence-level conversations.
Paragraph 180, Sentence 2 0
No sentence-level conversations.
Paragraph 180, Sentence 3 0
No sentence-level conversations.
Paragraph 180, Sentence 4 0
No sentence-level conversations.

181 2. Raichle ME, Plum F. Hyperventilation and Cerebral Blood Flow. Stroke. 1972;3(5):566-575.

Paragraph 181 0
No paragraph-level conversations.
Paragraph 181, Sentence 1 0
No sentence-level conversations.
Paragraph 181, Sentence 2 0
No sentence-level conversations.
Paragraph 181, Sentence 3 0
No sentence-level conversations.
Paragraph 181, Sentence 4 0
No sentence-level conversations.

182 3. Fletcher DJ, Boller M, Brainard BM, et al. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines: RECOVER clinical guidelines. J Vet Emerg Crit Care. 2012;22(s1):S102-S131.

Paragraph 182 0
No paragraph-level conversations.
Paragraph 182, Sentence 1 0
No sentence-level conversations.
Paragraph 182, Sentence 2 0
No sentence-level conversations.
Paragraph 182, Sentence 3 0
No sentence-level conversations.
Paragraph 182, Sentence 4 0
No sentence-level conversations.
Paragraph 182, Sentence 5 0
No sentence-level conversations.
Paragraph 182, Sentence 6 0
No sentence-level conversations.

183 4. Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S366-S468.

Paragraph 183 0
No paragraph-level conversations.
Paragraph 183, Sentence 1 0
No sentence-level conversations.
Paragraph 183, Sentence 2 0
No sentence-level conversations.
Paragraph 183, Sentence 3 0
No sentence-level conversations.
Paragraph 183, Sentence 4 0
No sentence-level conversations.
Paragraph 183, Sentence 5 0
No sentence-level conversations.

184 5. Hayes MM, Ewy GA, Anavy ND, et al. Continuous passive oxygen insufflation results in a similar outcome to positive pressure ventilation in a swine model of out-of-hospital ventricular fibrillation. Resuscitation. 2007;74(2):357-365.

Paragraph 184 0
No paragraph-level conversations.
Paragraph 184, Sentence 1 0
No sentence-level conversations.
Paragraph 184, Sentence 2 0
No sentence-level conversations.
Paragraph 184, Sentence 3 0
No sentence-level conversations.
Paragraph 184, Sentence 4 0
No sentence-level conversations.
Paragraph 184, Sentence 5 0
No sentence-level conversations.

185 6. Vissers G, Duchatelet C, Huybrechts SA, et al. The effect of ventilation rate on outcome in adults receiving cardiopulmonary resuscitation. Resuscitation. 2019;138:243-249.

Paragraph 185 0
No paragraph-level conversations.
Paragraph 185, Sentence 1 0
No sentence-level conversations.
Paragraph 185, Sentence 2 0
No sentence-level conversations.
Paragraph 185, Sentence 3 0
No sentence-level conversations.
Paragraph 185, Sentence 4 0
No sentence-level conversations.
Paragraph 185, Sentence 5 0
No sentence-level conversations.

186 7. Sanson G, Ristagno G, Caggegi GD, et al. Impact of “synchronous” and “asynchronous” CPR modality on quality bundles and outcome in out-of-hospital cardiac arrest patients. Intern Emerg Med. 2019;14(7):1129-1137.

Paragraph 186 0
No paragraph-level conversations.
Paragraph 186, Sentence 1 0
No sentence-level conversations.
Paragraph 186, Sentence 2 0
No sentence-level conversations.
Paragraph 186, Sentence 3 0
No sentence-level conversations.
Paragraph 186, Sentence 4 0
No sentence-level conversations.
Paragraph 186, Sentence 5 0
No sentence-level conversations.

187 8. Sutton RM, Reeder RW, Landis WP, et al. Ventilation Rates and Pediatric In-Hospital Cardiac Arrest Survival Outcomes. Crit Care Med. 2019;47(11):1627-1636.

Paragraph 187 0
No paragraph-level conversations.
Paragraph 187, Sentence 1 0
No sentence-level conversations.
Paragraph 187, Sentence 2 0
No sentence-level conversations.
Paragraph 187, Sentence 3 0
No sentence-level conversations.
Paragraph 187, Sentence 4 0
No sentence-level conversations.
Paragraph 187, Sentence 5 0
No sentence-level conversations.

188 9. Gazmuri RJ, Ayoub IM, Radhakrishnan J, Motl J, Upadhyaya MP. Clinically plausible hyperventilation does not exert adverse hemodynamic effects during CPR but markedly reduces end-tidal PCO(2). Resuscitation. 2012;83(2):259-264.

Paragraph 188 0
No paragraph-level conversations.
Paragraph 188, Sentence 1 0
No sentence-level conversations.
Paragraph 188, Sentence 2 0
No sentence-level conversations.
Paragraph 188, Sentence 3 0
No sentence-level conversations.
Paragraph 188, Sentence 4 0
No sentence-level conversations.
Paragraph 188, Sentence 5 0
No sentence-level conversations.

189 10. López J, Fernández SN, González R, et al. Different Respiratory Rates during Resuscitation in a Pediatric Animal Model of Asphyxial Cardiac Arrest. PLoS One. 2016;11(9):e0162185.

Paragraph 189 0
No paragraph-level conversations.
Paragraph 189, Sentence 1 0
No sentence-level conversations.
Paragraph 189, Sentence 2 0
No sentence-level conversations.
Paragraph 189, Sentence 3 0
No sentence-level conversations.
Paragraph 189, Sentence 4 0
No sentence-level conversations.
Paragraph 189, Sentence 5 0
No sentence-level conversations.

190 11. Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004;32(9 Suppl):S345-351.

Paragraph 190 0
No paragraph-level conversations.
Paragraph 190, Sentence 1 0
No sentence-level conversations.
Paragraph 190, Sentence 2 0
No sentence-level conversations.
Paragraph 190, Sentence 3 0
No sentence-level conversations.
Paragraph 190, Sentence 4 0
No sentence-level conversations.
Paragraph 190, Sentence 5 0
No sentence-level conversations.

191 12. Xu J, Yu X, Zhang L, et al. Modified volumetric capnography-derived parameter: A potentially stable indicator in monitoring cardiopulmonary resuscitation efficacy in a porcine model. Resuscitation. Published online 2020.

Paragraph 191 0
No paragraph-level conversations.
Paragraph 191, Sentence 1 0
No sentence-level conversations.
Paragraph 191, Sentence 2 0
No sentence-level conversations.
Paragraph 191, Sentence 3 0
No sentence-level conversations.
Paragraph 191, Sentence 4 0
No sentence-level conversations.
Paragraph 191, Sentence 5 0
No sentence-level conversations.

192 13. Luce JM, Ross BK, O’Quin RJ, et al. Regional blood flow during cardiopulmonary resuscitation in dogs using simultaneous and nonsimultaneous compression and ventilation. Circulation. 1983;67(2):258-265.

Paragraph 192 0
No paragraph-level conversations.
Paragraph 192, Sentence 1 0
No sentence-level conversations.
Paragraph 192, Sentence 2 0
No sentence-level conversations.
Paragraph 192, Sentence 3 0
No sentence-level conversations.
Paragraph 192, Sentence 4 0
No sentence-level conversations.
Paragraph 192, Sentence 5 0
No sentence-level conversations.

193 14. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-Induced Hypotension during Cardiopulmonary Resuscitation. Circulation. 2004;109(16):1960-1965.

Paragraph 193 0
No paragraph-level conversations.
Paragraph 193, Sentence 1 0
No sentence-level conversations.
Paragraph 193, Sentence 2 0
No sentence-level conversations.
Paragraph 193, Sentence 3 0
No sentence-level conversations.
Paragraph 193, Sentence 4 0
No sentence-level conversations.
Paragraph 193, Sentence 5 0
No sentence-level conversations.

194 15. Lurie KG, Yannopoulos D, McKnite SH, et al. Comparison of a 10-breaths-per-minute versus a 2-breaths-per-minute strategy during cardiopulmonary resuscitation in a porcine model of cardiac arrest. Respir Care. 2008;53(7):862-870.

Paragraph 194 0
No paragraph-level conversations.
Paragraph 194, Sentence 1 0
No sentence-level conversations.
Paragraph 194, Sentence 2 0
No sentence-level conversations.
Paragraph 194, Sentence 3 0
No sentence-level conversations.
Paragraph 194, Sentence 4 0
No sentence-level conversations.
Paragraph 194, Sentence 5 0
No sentence-level conversations.

DMU Timestamp: July 13, 2023 21:18

General Document Comments 0

Image
0 comments, 0 areas
add area
add comment
change display
Video
add comment

Quickstart: Commenting and Sharing

How to Comment
  • Click icons on the left to see existing comments.
  • Desktop/Laptop: double-click any text, highlight a section of an image, or add a comment while a video is playing to start a new conversation.
    Tablet/Phone: single click then click on the "Start One" link (look right or below).
  • Click "Reply" on a comment to join the conversation.
How to Share Documents
  1. "Upload" a new document.
  2. "Invite" others to it.

Logging in, please wait... Blue_on_grey_spinner