From the Guidelines
Manual chest compression is not an effective treatment for asthma, and standard ACLS guidelines should be followed in cases of cardiac arrest in patients with acute asthma. The American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care [ 1 ] do not recommend manual chest compression as a technique for managing asthma. Instead, asthma should be treated with inhaled bronchodilators and, in some cases, corticosteroids. For acute asthma attacks, patients should use their rescue inhaler and seek medical attention if symptoms don't improve.
Some key points to consider in managing asthma include:
- Using proper inhaler technique to ensure effective delivery of medication
- Avoiding triggers to prevent asthma exacerbations
- Following an asthma action plan developed with a healthcare provider
- Considering oxygen therapy and additional medications under medical supervision in severe cases
In cases of cardiac arrest in patients with acute asthma, the primary concern is to follow standard ACLS guidelines, which may include a ventilation strategy of low respiratory rate and tidal volume [ 1 ]. Additionally, a brief disconnection from the bag mask or ventilator may be considered, and compression of the chest wall to relieve air-trapping can be effective [ 1 ]. However, manual chest compression is not a recommended technique for managing asthma itself, as the primary issue is bronchial constriction and inflammation, not mucus plugging or secretion retention.
From the Research
Effectiveness of Manual Chest Compression in Asthma
- There is limited research on the effectiveness of manual chest compression in asthma, with most studies focusing on its use in cardiac arrest [ 2, 3 ].
- A study from 2001 discusses the use of mechanical external chest compression (MECC) in severe asthma, but notes that there are no published trials on the technique [ 2 ].
- Another study from 1989 describes a method for assisted expiration using external chest compression in asthmatic patients, but states that the technique requires further evaluation [ 3 ].
Comparison with Mechanical Chest Compression
- Studies comparing manual and mechanical chest compression in cardiac arrest have found mixed results, with some showing no difference in survival rates [ 4, 5 ].
- A 2018 systematic review found that mechanical chest compression devices are not superior to manual chest compressions, but may be a reasonable alternative in certain situations [ 5 ].
- A 2013 review discusses the role of manual and mechanical chest compressions during resuscitation efforts, but notes that the evidence is inconclusive [ 6 ].
Use in Asthma
- There is no direct evidence on the effectiveness of manual chest compression in asthma, and its use in this context is not well established [ 2, 3 ].
- The available evidence suggests that manual chest compression may be used in severe asthma as a last resort, but its effectiveness and safety are unknown [ 2 ].