Abstract
The three cases reported here illustrate the effect of ventilation during cardiopulmonary resuscitation (CPR) in infants with congenital heart disease accompanied with high pulmonary blood flow such as endocardial cushion defect, hypoplastic left heart, and large ventricular septal defect. Although use of high fraction of inspiratory oxygen (FIO2) and/or hyperventilation are performed in principle during CPR, these treatment can conversely break the balance between pulmonary and systemic vascular resistance in those peculiar hemodynamics. From clinical expe-riences we emphasize four practical purposes as follows: (1) temporary use of 100% oxygen and/or manual hyper-ventilation can be approved at the beginning of CPR, (2) to lower FIO2, if possible is desirable after the diagnosis of heart disease accompanied with high pulmonary blood flow or dependence of patent ductus arteriosus referring to oxygen saturation, (3) the method of ventilation without less reduction of pulmonary vascular resistance may be decided carefully considering into central nervous system, and (4) echocardiography should be performed not only during CPR but after recovery from cardiovascular instability to evaluate pulmonary blood flow. The artificial ventilation in regard to FIO2 and the method of ventilation during CPR should be carefully managed in patients with congenital heart disease.
