much of the existing literature is based on animal models or small human studies
successful ventilations per compression pause (“synchronous" ventilation, 30:2, without advanced airway) is unsurprisingly important for neurologically intact survival
no clear difference in outcomes between “synchronous” vs. “asynchronous” (insufflation without pause in CPR) ventilation
RR below 6 breaths per min were associated with decreased ROSC, whereas faster RR were not associated with worse outcomes (however, be cautious of breathstacking in pts with asthma/COPD)
chest rise can be detected with TVs as low as 180 mL which is likely not sufficient for CPR
the benefit of larger tidal volumes (improved oxygenation, less hypercapnia) may outweigh the perceived costs (gastric insufflation, impact on venous return/CO)
Take home pearls:
use 2-person BVM to ensure adequate TVs and aim for more than just minimal chest rise
err on the side of moderately larger TVs rather than smaller and moderately faster RR rather than slower (but be cautious in pts with asthma/COPD)
References
van Eijk JA, Doeleman LC, Loer SA, Koster RW, van Schuppen H, Schober P. Ventilation during cardiopulmonary resuscitation: A narrative review. Resuscitation. 2024;203:110366.
