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Research

Tools for accurate tidal volume calculation during out-of-hospital ventilation

02 June 2025
Research
02 June 2025
Volume 17 · Issue 6

Abstract

Background:

Out-of-hospital cardiac arrest in England affects approximately 60 000 individuals annually, with only 8% surviving to discharge. Accurate tidal volume calculation, based on predicted body weight, is essential to avoid hyperventilation and its associated risks.

Aims:

This systematic literature review aims to evaluate tools, which estimate height or weight in adults, to determine their suitability for use within prehospital settings, enabling accurate tidal volume calculation.

Methods:

A systematic literature review was conducted using MEDLINE and CINAHL databases to identify relevant studies on height and weight estimation tools. The review adhered to PRISMA guidelines and assessed study quality using a modified Newcastle-Ottawa Scale.

Findings:

In the prehospital care setting, three tools – ulna length, tidal tape, and the Modified PAWPER XL-MAC-2 – demonstrated good accuracy for weight estimation, with the Modified PAWPER XL-MAC-2 tool identified as the most likely to yield accurate results given the specific circumstances of prehospital care.

Conclusion:

Accurate height and weight estimation tools are essential for calculating tidal volumes in the management of out-of-hospital cardiac arrest. While the Modified PAWPER XL-MAC-2 appears effective, further research is needed to confirm its efficacy and practicality in prehospital settings.

Of the approximately 60 000 out-of-hospital cardiac arrests (OHCA) in England per annum, roughly 30 000 receive resuscitation care by the emergency services (Hawkes et al, 2017), around 7500 attain return of spontaneous circulation (ROSC), and less than 5000 survive to discharge (Perkins et al, 2016).

Ventilation of the patient is a key factor in determining outcomes in cardiac arrest (Van Schuppen et al, 2021), respiratory depression (Rowe et al, 2022), and certain acute strokes (Popat et al, 2018). Ventilation with an accurate tidal volume (TV) is independently associated with favourable neurological outcomes and correlates with earlier weaning from mechanical ventilation (Beitler et al, 2017). Hyperventilation is also associated with impaired venous return, further limiting the efficacy of resuscitation efforts (O'Neill and Deakin, 2007). Therefore, it is imperative that patients receive lung-protective tidal volumes (LPTV) in the prehospital setting.

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Tidal volume
Prehospital
Weight measurement
Height measurement
Ventilation
Hyperinflation