Letters to the Editor: Letters & Announcements
We thank Drs. Perkins and Gao (1) for their comments on our article (2) and for giving us the opportunity to clarify these issues. Our paper concluded that over-the-head cardiopulmonary resuscitation (CPR) provides equivalent quality of chest compressions compared with standard basic life support but delivers superior quality of ventilation. This finding was based on the observation that more ventilations with a correct tidal volume were administered in the over-the-head CPR group than in the standard group. As explicitly stated in our Methods section, we deliberately chose to define a correct tidal volume as between 400–800 mL, which corresponds to 7–10 mL/kg for a moderate weight adult (instead of a tidal volume of 700–1000 mL). Furthermore, the recently published 2005 Guidelines state explicitly that larger tidal volumes might be associated with complications (3) and that during adult basic life support tidal volumes of 500–600 mL (6–7 mL/kg) should suffice (class IIa recommendation) (4,5). One peculiar thing to note, however, is that Dr. Perkins criticizes our article for using the wrong tidal volume, although he also acts as one of the authors of the European Resuscitation Council Guidelines for Resuscitation 2005 responsible for recommending a smaller tidal volume (5)!
As for reporting the mean tidal volumes in the two groups, our software did not allow us to measure the actual delivered tidal volumes directly.
Drs. Perkins and Gao also state in their letter that our organization (St. John’s Ambulance) advocates mouth-to-mouth ventilation for professional rescuers. This is nonsense and cannot be inferred from our article. The whole emphasis of our manuscript was to present a solution for a situation in which a professional rescuer has to deliver basic life support alone without having to provide mouth-to-mouth ventilation, as the 2000 Guidelines otherwise would suggest (6).
Peter Nagele, MD
Department of Anesthesiology
Washington University, St. Louis Medical School
St. Louis, MO
Michael Hüpfl, MD
Department of Anesthesiology and General Intensive Care
Medical University of Vienna
1. Perkins GD, Gao F. Over-the-head CPR. Anesth Analg 2006;103:498.
2. Hupfl M, Duma A, Uray T et al. Over-the-head cardiopulmonary resuscitation improves efficacy in basic life support performed by professional medical personnel with a single rescuer: a simulation study. Anesth Analg 2005;101:200–5.
3. International Liaison Committee on Resuscitation. Part 2: adult basic life support. Resuscitation 2005;67:187–201.
4. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 4: adult basic life support. Circulation 2005;112:(Suppl 1):19–34.
5. Handley AJ, Koster R, Monsieurs K et al. European Resuscitation Council Guidelines for Resuscitation 2005: Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2005;67:S7–S23.
6. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Part 3: adult basic life support. Resuscitation 2000;46:29–71.