Mechanical Ventilation vs. Manual Bag Ventilation during CPR

The effectiveness of mechanical ventilation as a replacement for manual bag ventilation during cardiopulmonary resuscitation (CPR) remains uncertain. A recent pilot randomized controlled trial aimed to assess the feasibility and comparability of automatic mechanical ventilation versus manual bag ventilation during CPR for out-of-hospital cardiac arrest (OHCA) patients.

This study was published in the CHEST journal by Jonghwan Shin and colleagues. Manual bag ventilation is a standard method used during CPR, but it can be labor-intensive and inconsistent. The potential for automatic mechanical ventilation to provide reliable and efficient ventilation during CPR is of interest, but its feasibility and effectiveness require further investigation.

The pilot study included 60 patients with medical OHCA arriving at the emergency department. Patients were randomly assigned to either the mechanical ventilation (MV) group or the bag ventilation (BV) group. The primary outcome was any return-of-spontaneous circulation (ROSC), and secondary outcomes included changes in arterial blood gas analysis results during CPR. Tidal volume, minute volume, and peak airway pressure were also analyzed.

Key Findings:

• 30 patients were assigned to each group, with no significant differences in basic characteristics between the MV and BV groups.
• The rate of any ROSC was 56.7% in the MV group and 43.3% in the BV group, with no significant difference observed.
• Changes in arterial blood gas analysis results during CPR did not significantly differ between the two groups.
• The MV group showed significantly lower tidal volume and minute volume compared to the BV group.

The pilot trial demonstrated the feasibility of using mechanical ventilation instead of manual bag ventilation during CPR for OHCA patients. While there was no significant difference in ROSC rates between the two methods, mechanical ventilation may offer a viable alternative. Further research, including multicenter randomized controlled trials, is warranted to establish ventilation guidelines during CPR definitively.

Reference:

Shin, J., Lee, H. J., Jin, K. N., Shin, J. H., You, K. M., Lee, S. G. W., Jung, J. H., Song, K. J., Pak, J., Park, T. Y., Park, C. J., & Bae, G. T. (2024). Automatic Mechanical Ventilation versus Manual Bag Ventilation during Cardiopulmonary Resuscitation: A Pilot Randomized Controlled Trial. CHEST. https://doi.org/10.1016/j.chest.2024.02.020