• Kristina Fuest, Florian Dorfhuber, Marco Lorenz, Falk von Dincklage, Rudolf Mörgeli, KuhnKarl FriedrichKFCharité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine, Charitéplatz 1, Berlin, Germany., Bettina Jungwirth, Karl-Georg Kanz, Manfred Blobner, and Stefan J Schaller.
• Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care, Ismaninger Str. 22, Munich, Germany.
• Resuscitation. 2021 Sep 1; 166: 85-92.

Aim Of The StudyAutomated mechanical chest compression devices (AMCCDs) can help performing high-quality cardiopulmonary resuscitation (CPR). Guidelines for CPR are lacking information about the optimal ventilation mode during CPR using AMCCDs. Aim of this pilot study was to compare three common ventilation modes during CPR using AMCCD.MethodsIn this randomized controlled trial, we included patients with an out-of-hospital cardiac arrest arriving at the resuscitation room receiving chest compressions via AMCCD with an expected continuation of at least 15 min. Patients were randomly assigned to three groups: biphasic positive airway pressure with assisted spontaneous ventilation (BIPAP) with assisted spontaneous breathing, continuous positive airway pressure (CPAP) and volume-controlled ventilation (VCV). Outcomes were tidal volume, respiratory minute volume, and end-tidal CO2 during the study period. Groups were compared using generalized linear models. Data is given as median and interquartile ranges.ResultsOf 53 screened patients, 30 were randomized. The tidal volume was significantly (p < 0.05) lower in patients of the CPAP group (68 [64-83] ml) compared with those of the BIPAP (349 [137-500] ml), while the respiratory minute volume differed between the CPAP group (6.2 [5.3-8.1] l/min) and both the BIPAP (7.1 [6.7-10.2] l/min) and VCV group (7.2 [3.7-8.4] l/min).ConclusionsAll ventilation modes achieved an adequate respiratory minute volume during CPR with an AMCCD. However, BIPAP seems to be superior due to the higher tidal volume. Therefore, we recommend starting mechanical ventilation when using AMCCD with BIPAP ventilation to avoid risks related to dead space ventilation.Copyright © 2021 Elsevier B.V. All rights reserved.

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