Transport mechanical ventilation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: an exploratory prehospital pilot study.
BMC Emergency Medicine · 2026-07-29 · Observational study
Abstract
BACKGROUND: Evidence regarding the use of mechanical ventilation (MV) during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) remains limited, particularly in prehospital settings. OBJECTIVE: To evaluate the feasibility and generate preliminary physiologic data regarding transport MV compared with bag-valve ventilation (BV) during CPR in OHCA. METHODS: This prospective, time-sequenced, exploratory pilot study, conducted between September 2024 and October 2025, included adult OHCA patients aged ≥ 18 years managed by the Ramathibodi Emergency Medical Operation team. Patients received BV during the first 6 months, followed by MV thereafter, delivered using a HAMILTON-T1 transport mechanical ventilator in volume-controlled mode (tidal volume: 6-8 mL/kg; respiratory rate: 10 breaths/min; PEEP: 0 cmH₂O; I:E ratio: 1:5; FiO₂: 1.0; flow trigger: off). Ventilation was assessed using arterial or venous PCO₂ obtained after ≥ 3 min following intubation or upon return of spontaneous circulation (ROSC). As a pilot study, this investigation was not powered to detect differences in clinical outcomes. RESULTS: Forty-one patients were analysed (29 BV, 12 MV). The mean age was 67 ± 15 years in the BV group and 66 ± 20 years in the MV group, with 55.2% and 66.7% male patients, respectively. No statistically significant differences were detected in PCO₂, pH, or pO₂ between groups. Clinical outcomes, including sustained ROSC and 28-day survival, were also similar between groups. Mechanical ventilation was operationally feasible in the prehospital setting despite several implementation challenges. CONCLUSION: In this exploratory prehospital pilot study, MV during CPR was feasible and produced preliminary physiologic measures comparable to BV. These findings are hypothesis-generating and may inform the design of future adequately powered studies. TRIAL REGISTRATION: The study protocol was registered with the Thai Clinical Trials Registry (TCTR20241008007; 08 October 2024).
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Tags
Bag-valve-mask ventilation · Endotracheal intubation · Mechanical ventilation · Mortality & survival
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