anesjc.com - September 2023

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Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials

September, 2023

Journal: Anesthesia and Analgesia
PMID: 37010960
Type of study: Randomized controlled trial
Objective
- To evaluate the efficacy of modified manual chest compression (MMCC) for reducing oxygen desaturation events in patients undergoing upper gastrointestinal endoscopy under deep sedation
Methods
- Randomized controlled trial
- Only statistical analysts blinded to the intervention
- Single center in China
- 2017 - 2021
- Primary outcome
  - Preventative cohort: occurrence of desaturations events (SpO2 <95%) at any point during gastroscopy
  - Therapeutic cohort: cumulative time spent <95% SpO2
- 584 patients
  - 444 in preventative cohort
  - 140 in therapeutic cohort
  - Multicenter Perioperative Outcomes Group
- Inclusion criteria
  - Adults age 18-65
  - ASA physical status I-III
  - Underwent elective deep sedation during gastroscopy
- Exclusion criteria
  - Coagulopathies
  - Severe cardiopulmonary disorders
  - Baseline Spo2<95%
  - Thoracic deformity, rib fractures, hx of chest or abdominal surgery
  - Allergy to propofol, eggs, soybean or albumin
- Intervention
  - Preventative cohort
    - 20 MMCC's at a frequency of 100-120 times/min prior to gastroscopy
    - If desaturation occurred (Spo2<95%), further medication and/or MMCC's were withheld and jaw thrust was performed
  - Therapeutic cohort
    - When desaturation occurred, jaw thrust was performed and O2 flow was increased to 5L/min
    - 20 MMCC's were performed at a rate of 2 compressions a second for 10 seconds
- Results
  - Preventative cohort
    - MMCC reduced the incidence of desaturation episodes <95% (14.4% vs 26.1%; RR, 0.549; 95% confidence interval [CI], 0.37-0.815; P = .002) and gastroscopy withdrawal (0% vs 2.29%; P = .008)
  - Therapeutic cohort
    - MMCC reduced the amount of time spent below 95% SpO2 (40 [20-69] seconds vs 91 [33-152] seconds, median difference [95% CI], -39 [-57 to -16] seconds, P < .001) and resulted in a lower incidence of gastroscopy withdrawal (0% vs 10.4%, P = .018)
Strengths
- Randomized controlled trial
- Large, well-powered
- Data analysis was blinded
- Integrity in study design
Weaknesses
- Limited blinding
- Mostly ASA physical status I & II
- Excluded significant comorbidities
- Few obese patients or patients with OSA
- Very short procedure length
- Propofol administered as boluses
- Limited generalizability to other GI procedures or other procedures performed under sedation
Key Point: MMCC (preventatively and therapeutically) reduces oxygen desaturation during GI procedures under sedation

Anesth Analg. 2023 Oct 1;137(4):859-869

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Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials

Journal: Anesthesia and Analgesia

PMID: 37010960

Type of study: Randomized controlled trial

Objective

Methods

Randomized controlled trial

Only statistical analysts blinded to the intervention

Single center in China

2017 - 2021

Primary outcome

Preventative cohort: occurrence of desaturations events (SpO2 <95%) at any point during gastroscopy

Therapeutic cohort: cumulative time spent <95% SpO2

584 patients

444 in preventative cohort

140 in therapeutic cohort

Inclusion criteria

Adults age 18-65

ASA physical status I-III

Underwent elective deep sedation during gastroscopy

Exclusion criteria

Coagulopathies

Severe cardiopulmonary disorders

Baseline Spo2<95%

Thoracic deformity, rib fractures, hx of chest or abdominal surgery

Allergy to propofol, eggs, soybean or albumin

Intervention

Preventative cohort

20 MMCC's at a frequency of 100-120 times/min prior to gastroscopy

If desaturation occurred (Spo2<95%), further medication and/or MMCC's were withheld and jaw thrust was performed

Therapeutic cohort

When desaturation occurred, jaw thrust was performed and O2 flow was increased to 5L/min

20 MMCC's were performed at a rate of 2 compressions a second for 10 seconds

Results

Preventative cohort

MMCC reduced the incidence of desaturation episodes <95% (14.4% vs 26.1%; RR, 0.549; 95% confidence interval [CI], 0.37-0.815; P = .002) and gastroscopy withdrawal (0% vs 2.29%; P = .008)

Therapeutic cohort

MMCC reduced the amount of time spent below 95% SpO2 (40 [20-69] seconds vs 91 [33-152] seconds, median difference [95% CI], -39 [-57 to -16] seconds, P < .001) and resulted in a lower incidence of gastroscopy withdrawal (0% vs 10.4%, P = .018)

Strengths

Randomized controlled trial

Large, well-powered

Data analysis was blinded

Integrity in study design

Weaknesses

Limited blinding

Mostly ASA physical status I & II

Excluded significant comorbidities

Few obese patients or patients with OSA

Very short procedure length

Propofol administered as boluses

Limited generalizability to other GI procedures or other procedures performed under sedation

Key Point: MMCC (preventatively and therapeutically) reduces oxygen desaturation during GI procedures under sedation

Anesth Analg. 2023 Oct 1;137(4):859-869

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