Respiratory outcomes and complications in patients with cardiac arrest according to ventilation strategy: subanalysis of the SYMEVECA study.
Emergencias · 2026-06-01 · Quasi-experimental
Abstract
OBJECTIVE: This analysis evaluates respiratory outcomes and the occurrence of respiratory complications during the first 24 hours after hospital admission, according to the ventilatory strategy used during out-of-hospital cardiopulmonary resuscitation, including a group with a ventilatory mode synchronized with chest compressions. METHODS: Pragmatic quasi-experimental study including all patients with out of hospital cardiac arrest with persistence of cardiac arrest 3 minutes after early intubation who were transferred to a hospital. Duration: 3.5 years. Patients were grouped according to ventilation strategy: Chest Compression Synchronized Ventilation (CCSV), Intermittent Positive Pressure Ventilation (IPPV), or bag-valve ventilation. Radiological findings (pneumothorax, signs of barotrauma, and pulmonary infiltrates according to the Modified Chest X-ray Scoring System) and arterial blood gas parameters within the first 24 hours after hospital admission were analyzed. RESULTS: A total of 278 patients transferred to a hospital were included, and 68 were excluded because no radiological study was performed due to immediate certification of death (22.7% women, mean age 61.9 (SD, 16.5) years, 44.3% with shockable rhythm): 41 in the CCSV group, 65 in the IPPV group, and 104 with bag-valve ventilation. PaO2/FiO2 values were, respectively, 247 (SD, 162), 200 (SD, 117), and 202 (SD, 118) mmHg (P < .05 between CCSV and the other groups). Pneumothorax or subcutaneous emphysema was found in 2.4% of patients ventilated with CCSV, 10.8% with IPPV, and 6.7% with bag-valve ventilation (P = .26). The Modified Chest X-ray Score was, respectively, 4.6 (SD, 3.1), 5.7 (SD, 3.3), and 5.1 (SD, 3.1) (P = .23). CONCLUSIONS: CCSV is associated with better PaO2/FiO2 at 24 hours vs other ventilation strategies. There was no higher incidence rate of pneumothorax with CCSV, and no significant differences were found in the development of radiological infiltrates.
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Tags
Bag-valve-mask ventilation · Mechanical ventilation
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