Keywords
Mechanical ventilation
CPR
cardiac arrest
airway management
resuscitation
Introduction
Effective ventilation during CPR is essential to optimise oxygenation while preserving hemodynamic stability. Although bag-valve ventilation remains standard, mechanical ventilation enables delivery of controlled tidal volumes and respiratory rates, minimising variability and risk of harmful hyperventilation associated with manual ventilation. Automating ventilation in CPR could allow providers to focus on critical resuscitation priorities.
Objectives
To describe and evaluate a structured mechanical ventilation strategy during CPR to optimise ventilation while minimising adverse hemodynamic effects.
Methods
Narrative review of current resuscitation guidelines and literature, incorporating the “six-dial” ventilator strategy, focusing on physiological principles and practical application during CPR in emergency settings.
Results
The six-dial strategy recommends volume control mode, zero PEEP, tidal volume 8 mL/kg, FiO? 100%, respiratory rate 10/min, Pmax 60 cmH?O, trigger off, and I:E ratio 1:5. These settings reduce hyperventilation, improve oxygenation, and preserve venous return during CPR.
Discussion
Mechanical ventilation during CPR can improve workflow efficiency and reduce provider error. Key physiological considerations include avoiding hyperventilation, limiting intrathoracic pressure, and ensuring adequate oxygen delivery. The six-dial approach provides a standardised framework aligned with resuscitation physiology, though evidence remains limited and largely observational.
Conclusion
A structured mechanical ventilation approach during CPR may improve resuscitation quality. Further clinical studies are needed to validate optimal ventilator strategies and their impact on survival outcomes.
References
Sahu AK et al. Six-dial strategy—Mechanical ventilation during CPR. IJCCM, 2020.
