Automatic Mechanical Ventilation vs Manual Bag Ventilation During CPR: A Pilot Randomized Controlled Trial

Jonghwan Shin; Hui Jai Lee; Kwang Nam Jin; Jung Ho Shin; Kyoung Min You; Stephen Gyung Won Lee; Jin Hee Jung; Kyoung Jun Song; Jieun Pak; Tae Yun Park; Chang Je Park; Gi Tak Bae

doi:10.1016/j.chest.2024.02.020

Automatic Mechanical Ventilation vs Manual Bag Ventilation During CPR: A Pilot Randomized Controlled Trial

Chest. 2024 Feb 18:S0012-3692(24)00248-4. doi: 10.1016/j.chest.2024.02.020. Online ahead of print.

Authors

Jonghwan Shin¹, Hui Jai Lee², Kwang Nam Jin³, Jung Ho Shin⁴, Kyoung Min You⁴, Stephen Gyung Won Lee⁴, Jin Hee Jung⁴, Kyoung Jun Song¹, Jieun Pak⁴, Tae Yun Park⁵, Chang Je Park⁴, Gi Tak Bae⁶

Affiliations

¹ Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
² Department of Emergency Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea. Electronic address: emdrlee@gmail.com.
³ Department of Radiology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
⁴ Department of Emergency Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
⁵ Department of Internal Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
⁶ Department of Nursing, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.

PMID: 38373673
DOI: 10.1016/j.chest.2024.02.020

Abstract

Background: There is insufficient evidence supporting the theory that mechanical ventilation can replace the manual ventilation method during CPR.

Research question: Is using automatic mechanical ventilation feasible and comparable to the manual ventilation method during CPR?

Study design and methods: This pilot randomized controlled trial compared automatic mechanical ventilation (MV) and manual bag ventilation (BV) during CPR of out-of-hospital cardiac arrest (OHCA). Patients with medical OHCA arriving at the ED were randomly assigned to two groups: an MV group using a mechanical ventilator and a BV group using Ambu-bag. Primary outcome was any return-of-spontaneous circulation (ROSC). Secondary outcomes were changes of arterial blood gas analysis results during CPR. Tidal volume, minute volume, and peak airway pressure were also analyzed.

Results: A total of 60 patients were enrolled, and 30 patients were randomly assigned to each group. There were no statistically significant differences in basic characteristics of OHCA patients between the two groups. The rate of any ROSC was 56.7% in the MV group and 43.3% in the BV group, indicating no significant (P = .439) difference between the two groups. There were also no statistically significant differences in changes of PH, Pco₂, Po₂, HCO₃, or lactate levels during CPR between the two groups (P values = .798, 0.249, .515, .876, and .878, respectively). Significantly lower V_T (P < .001) and minute volume (P = .009) were observed in the MV group.

Interpretation: In this pilot trial, the use of MV instead of BV during CPR was feasible and could serve as a viable alternative. A multicenter randomized controlled trial is needed to create sufficient evidence for ventilation guideline during CPR.

Clinical trial registration: ClinicalTrials.gov; No.: NCT05550454; URL: www.

Clinicaltrials: gov.

Keywords: CPR; randomized controlled trial; ventilation.

Associated data

ClinicalTrials.gov/NCT05550454