Abstract
Aim of the study
This study sought to assess the effects of increasing the ventilatory rate from 10 min−1 to 20 min−1 using a mechanical ventilator during cardio-pulmonary resuscitation (CPR) for out-of-hospital
cardiac arrest (OHCA) on ventilation, acid-base-status, and outcomes.
Methods
This was a randomised, controlled, single-centre trial in adult patients receiving
CPR including advanced airway management and mechanical ventilation offered by staff
of a prehospital physician response unit (PRU). Ventilation was conducted using a
turbine-driven ventilator (volume-controlled ventilation, tidal volume 6 ml per kg
of ideal body weight, positive end-expiratory pressure (PEEP) 0 mmHg, inspiratory
oxygen fraction (FiO2) 100%), frequency was pre-set at either 10 or 20 breaths per minute according to
week of randomisation. If possible, an arterial line was placed and blood gas analysis
was performed.
Results
The study was terminated early due to slow recruitment. 46 patients (23 per group)
were included. Patients in the 20 min−1 group received higher expiratory minute volumes [8.8 (6.8–9.9) vs. 4.9 (4.2–5.7)
litres, p < 0.001] without higher mean airway pressures [11.6 (9.8–13.6) vs. 9.8 (8.5–12.0)
mmHg, p = 0.496] or peak airway pressures [42.5 (36.5–45.9) vs. 41.4 (32.2–51.7) mmHg, p = 0.895]. Rates of ROSC [12 of 23 (52%) vs. 11 of 23 (48%), p = 0.768], median pH [6.83 (6.65–7.05) vs. 6.89 (6.80–6.97), p = 0.913], and median pCO2 [78 (51–105) vs. 86 (73–107) mmHg, p > 0.999] did not differ between groups.
Conclusion
20 instead of 10 mechanical ventilations during CPR increase ventilation volumes per
minute, but do not improve CO2 washout, acidaemia, oxygenation, or rate of ROSC.
ClinicalTrials.gov Identifier: NCT04657393.
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Article info
Publication history
Published online: March 15, 2023
Accepted:
March 4,
2023
Received in revised form:
March 3,
2023
Received:
December 18,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
