SAMUR-Protección Civil, Madrid, Spain.
Resuscitation. 2023 Nov;192:109965. doi: 10.1016/j.resuscitation.2023.109965. Epub 2023 Sep 12.
To analyze differences in ventilatory parameters and outcome with different ventilatory methods during CPR.
Pragmatic prospective quasi-experimental study in out-of-hospital urban environment. Patients over 18 years of age in non-traumatic cardiac arrest, attended by an emergency medical service between April 2021 and September 2022, were included. Two groups were compared according to the ventilatory method: mechanical ventilator (IPPV, tidal volume 7 ml/kg, frequency 10-12 bpm) or manual resuscitator bag. The main variables of interest are those of gasometry performed 15 minutes after intubation or when spontaneous circulation is recovered and final outcome. Patients were followed up to hospital discharge.
Of the 359 patients attended, 150 were included (71 in IPPV and 79 with a bag). In patients with arterial blood gases, pCO was 67.8 ± 21.1 in the IPPV group vs 95.9 ± 39.0 mmHg in the bag group (p = 0.006) and pH was 7.00 ± 0.18 vs 6.92 ± 0.18 (p = 0.18). With a venous sample, the pCO was 68.1 ± 18.9 vs 89.5 ± 26.5 mmHg (p < 0.001) and the pH was 7.03 ± 0.15 vs 6.94 ± 0.17 (p = 0.005), respectively. Survival with CPC 1-2 to hospital discharge was 15.6% with IPPV and 11.3% with bag (p = 0.44).
The use of a mechanical ventilator in IPPV was associated with a better ventilatory status during CPR compared to the use of the bag, without conclusive data regarding its clinical repercussion with the sample collected.
分析心肺复苏（CPR）期间不同通气方式的通气参数和结果差异。
这是一项在院外城市环境中进行的实用前瞻性准实验研究。纳入 2021 年 4 月至 2022 年 9 月间由急救医疗服务中心救治的年龄大于 18 岁的非创伤性心搏骤停患者。根据通气方式将患者分为两组：机械通气（IPPV，潮气量 7ml/kg，频率 10-12bpm）或手动复苏袋。主要观察指标为通气 15 分钟后或自主循环恢复时的血气分析结果以及最终结果。对患者进行随访直至出院。
共纳入 359 例患者，其中 150 例（IPPV 组 71 例，复苏袋组 79 例）纳入分析。动脉血气分析中，IPPV 组患者的 pCO2 为 67.8±21.1mmHg，复苏袋组为 95.9±39.0mmHg（p=0.006），pH 值分别为 7.00±0.18 和 6.92±0.18（p=0.18）。静脉血气分析中，pCO2 分别为 68.1±18.9mmHg 和 89.5±26.5mmHg（p<0.001），pH 值分别为 7.03±0.15 和 6.94±0.17（p=0.005）。出院时，CPR 后患者的 CPC 1-2 评分存活率分别为 IPPV 组 15.6%和复苏袋组 11.3%（p=0.44）。
与使用复苏袋相比，CPR 期间使用机械通气（IPPV）可改善通气状态，但本研究样本量较小，尚无法得出其对临床结果的影响。
