Effect of bag valve ventilation versus mechanical ventilation after endotracheal intubation during cardiopulmonary resuscitation on outcomes following out-of-hospital cardiac arrest: a propensity score analysis.

BACKGROUND

In this study, we aimed to evaluate the impact of mechanical ventilator (MV) utilizaton during cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patient clinical outcomes in the emergency department.

METHODS

This single-centered, retrospective, case-control study analyzed electronic medical records. Patients aged >18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included. These patients were accessed according to the ventilatory method used: MV ventilation (volume control, tidal volume 6-8 mL/kg, frequency 10 beat per minute, inspiratory time 1 s) and manual resuscitator bag valve (BV) ventilation. The primary outcome was the return of spontaneous circulation (ROSC). After 1:1 propensity score matching, the clinical outcomes were analyzed.

RESULTS

A total of 649 patients were enrolled in this study. Before matching, the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups. After 1:1 matching between the two groups using propensity scores, 522 patients (261 MV and 261 BV) were analyzed. Propensity score matching yielded an adequate balance (standardized mean difference <0.10) for all covariates. The estimated odds ratio (OR) for ROSC was 1.23 (95% confidence interval [CI]: 0.85-1.77; P=0.267), for survival at hospital admission was 1.02 (95%CI: 0.68-1.53; P=0.918), for survival at hospital discharge was 2.31 (95%CI: 1.10-5.20; P=0.033), and for good neurologic outcome was 2.56 (95%CI: 0.84-9.43; P= 0.116).

CONCLUSION

In patients with OHCA admitted to the emergency department, MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures. However, survival at hospital discharge was significantly higher in the MV group, suggesting potential benefits of MV use in selected patients.