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.
Department of Emergency Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
Chest. 2024 Aug;166(2):311-320. doi: 10.1016/j.chest.2024.02.020. Epub 2024 Feb 18.
There is insufficient evidence supporting the theory that mechanical ventilation can replace the manual ventilation method during CPR.
Is using automatic mechanical ventilation (MV) feasible and comparable to the manual ventilation method during CPR?
This 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.
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 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, Pco, Po, 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.
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 guidelines during CPR.
ClinicalTrials.gov; No.: NCT05550454; URL: www.
gov.
机械通气在 CPR 中替代手动通气方法的理论依据不足。
在 CPR 中使用自动机械通气（MV）是否可行且与手动通气方法相当？
这项前瞻性随机对照试验比较了院外心脏骤停（OHCA）后心肺复苏（CPR）期间 MV 与手动球囊通气（BV）。到达急诊室的患有医学性 OHCA 的患者被随机分配到两组：使用呼吸机的 MV 组和使用球囊面罩的 BV 组。主要结局是任何自主循环恢复（ROSC）。次要结局是 CPR 期间动脉血气分析结果的变化。还分析了潮气量、分钟通气量和气道峰压。
共纳入 60 例患者，每组 30 例。两组 OHCA 患者的基本特征无统计学差异。MV 组 ROSC 率为 56.7%，BV 组为 43.3%，两组间无显著差异（P=.439）。CPR 期间 PH、Pco、Po、碳酸氢盐和乳酸水平的变化在两组之间也无统计学差异（P 值分别为 0.798、0.249、0.515、0.876 和 0.878）。MV 组的潮气量（P<.001）和分钟通气量（P=.009）显著降低。
在这项初步试验中，CPR 期间使用 MV 替代 BV 是可行的，可以作为一种可行的替代方法。需要进行多中心随机对照试验，为 CPR 期间的通气指南提供充分的证据。
ClinicalTrials.gov；编号：NCT05550454；网址：www.clinicaltrials.gov。
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