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• W2152372535 abstract "I would like to suggest that exercise involvement at the time of cardiac arrest should be considered to be a contra-indication to chest compression-only cardiopulmonary resuscitation (CPR) by first responders to out-of-hospital cardiac arrest. Outcome studies supporting CPR without ventilation of the lungs are not stratified for exercise involvement at the time of cardiac arrest. In animal models performance of chest compression-only CPR is associated with absence of effective alveolar ventilation, loss of lung volume and early development of significant atelectasis [1-3]. Chest compression-only CPR must be associated with progressive systemic arterial hypoxaemia due both to falling alveolar oxygen tension and to increasing intrapulmonary shunt. The rate at which arterial oxygen saturation (Spo2) falls must affect the cost-benefit balance of performing CPR without ventilation of the lungs. A substantial fall in mixed venous oxygen content (Cvo2) and increase in arterio-mixed venous oxygen content difference (Ca-vo2) occur during exercise. An exercise-induced increase in Ca-vo2 will increase the rate of pulmonary oxygen uptake and the rate of alveolar oxygen depletion generated by any given level of effective alveolar perfusion produced by external cardiac compression. An exercise-induced decrease in Cvo2 will result in a greater difference in oxygen content between shunted blood and alveolar end-capillary blood in early chest compression-only CPR. This will increase the effect of any given intrapulmonary shunt fraction on systemic arterial oxygen content (Cao2) and Sao2. These effects can clearly be predicted to accelerate the rate of fall in the systemic oxygen delivery in chest compression-only CPR. Data on systemic venous oxygen saturation (Svo2) in exercise show mean Svo2 to be 45.5% and 25.5% at exercise intensities equating to 5.1 metabolic equivalent units (MET) and at 10.1 MET respectively [4]. Ca-vo2 was 1.85 and 2.7 times normal resting level at 5.1 MET and 10.1 MET respectively [4]. Based on these figures a substantially more rapid fall in Sao2 and systemic oxygen delivery can be predicted when chest compression-only CPR is performed on patients who were exercising at the time of cardiac arrest, compared to previously resting patients. This can be predicted for relatively modest pre-morbid exercise intensities. In the absence of supporting exercise-specific outcome evidence, exercise involvement at the time of cardiac arrest should be considered to be a contra-indication to the performance of CPR without ventilation of the lungs." @default.
• W2152372535 created "2016-06-24" @default.
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• W2152372535 date "2009-11-01" @default.
• W2152372535 modified "2023-09-24" @default.
• W2152372535 title "Exercise involvement at cardiac arrest and chest compression-only cardiopulmonary resuscitation" @default.
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• W2152372535 doi "https://doi.org/10.1111/j.1365-2044.2009.06119.x" @default.
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