strong>Resuscitation Beitler JR, et al. Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation After Cardiac Arrest. American journal of respiratory and critical care medicine 2017. PMID: 28267376
- Low tidal volume was neuroprotective post-arrest.
Odds of neurologically-intact survival after cardiac arrest increased 60% for every 1 mL/kg decrease in tidal volume (Vt) (obviously with a lower limit around 6mL/kg…don’t crank it down to zero) compared with patients ventilated at >8 mL/kg. Those with Vt <8 mL/kg had a cerebral performance category 1 or 2 (CPC 1 or 2 = good outcome) 27% of the time; only 12% with Vt >8 mL/kg had a CPC 1 or 2. That’s a NNT of 7. They used propensity-adjusted analysis to account for potential confounders. Lower Vt was also associated with improvement in several other secondary outcomes and didn’t appear to have any adverse effects. Based on this rigorous analysis, I think the results are probably true. This is big news and easy to implement immediately.
If there was a drug that made this big an impact on cognitive outcome post-arrest, Big Pharma would bottle and sell it for billions.
- Recommended by: Clay Smith
- Read more: Low Tidal Volume Neuroprotective Post-Arrest (EM Topics)