Background Resuscitation guidelines recommend delivering ventilations at a rate of 10min^-1; however, hyperventilation is commonly reported during out-of-hospital cardiac arrest resuscitation efforts, and the impact of this on patient outcomes is unclear. This review explores the reported rates, causes, and patient outcomes of hyperventilation in the management of out-of-hospital cardiac arrest.

Methods A systematic literature review with narrative synthesis of three databases.

Findings Thirteen papers were identified as meeting the eligibility criteria. These showed ventilations are consistently delivered at a rate & tidal volume higher than is internationally recommended. Hyperventilation can occur due to clinician stress and lack of situational awareness, poor leadership, and a focus on other clinical interventions.

Conclusions Hyperventilation is common during cardiac arrest management. Current human data does not produce sufficient evidence to favour any ventilation strategy; however, a harmful upper limit will exist. This review found no human randomised control studies examining how ventilation rate, tidal volume, or pressure effect patient outcomes and this warrants further research.