Mechanical ventilation with ten versus twenty breaths per minute during cardio-pulmonary resuscitation for out-of-hospital cardiac arrest: A randomised controlled trial

Gerhard Prause; Philipp Zoidl; Michael Eichinger; Michael Eichlseder; Simon Orlob; Felix Ruhdorfer; Gabriel Honnef; Philipp G H Metnitz; Paul Zajic

doi:10.1016/j.resuscitation.2023.109765

Mechanical ventilation with ten versus twenty breaths per minute during cardio-pulmonary resuscitation for out-of-hospital cardiac arrest: A randomised controlled trial

Resuscitation. 2023 Jun:187:109765. doi: 10.1016/j.resuscitation.2023.109765. Epub 2023 Mar 15.

Authors

Gerhard Prause¹, Philipp Zoidl², Michael Eichinger¹, Michael Eichlseder¹, Simon Orlob³, Felix Ruhdorfer¹, Gabriel Honnef¹, Philipp G H Metnitz¹, Paul Zajic¹

Affiliations

¹ Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
² Division of General Anaesthesiology, Emergency- and Intensive Care Medicine, Medical University of Graz, Graz, Austria. Electronic address: https://twitter.com/PhZoidl.
³ Division of Anaesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.

PMID: 36931453
DOI: 10.1016/j.resuscitation.2023.109765

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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiopulmonary Resuscitation*
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Positive-Pressure Respiration
Pressure
Respiration, Artificial

Associated data

ClinicalTrials.gov/NCT04657393