• 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, and Gi Tak Bae.
• Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Emergency Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
• Chest. 2024 Aug 1; 166 (2): 311320311-320.

BackgroundThere is insufficient evidence supporting the theory that mechanical ventilation can replace the manual ventilation method during CPR.Research QuestionIs using automatic mechanical ventilation (MV) feasible and comparable to the manual ventilation method during CPR?Study Design And MethodsThis pilot randomized controlled trial compared MV and manual bag ventilation (BV) during CPR after 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 a bag valve mask. 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.ResultsA 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 return of spontaneous circulation 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, bicarbonate, or lactate levels during CPR between the two groups (P values = .798, 0.249, .515, .876, and .878, respectively). Significantly lower tidal volume (P < .001) and minute volume (P = .009) were observed in the MV group.InterpretationIn 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 guidelines during CPR.Clinical Trial RegistrationClinicalTrials.gov; No.: NCT05550454; URL: www.Clinicaltrialsgov.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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