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Background <p>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.</p> Objective <p>To evaluate the feasibility and generate preliminary physiologic data regarding transport MV compared with bag-valve ventilation (BV) during CPR in OHCA.</p> Methods <p>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&#xa0;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.</p> Results <p>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.</p> Conclusion <p>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.</p> Trial registration <p>The study protocol was registered with the Thai Clinical Trials Registry (TCTR20241008007; 08 October 2024).</p>

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Transport mechanical ventilation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: an exploratory prehospital pilot study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • Welawat Tienpratarn,
  • Pariyakon Kusolthammarat,
  • Chaiyaporn Yuksen,
  • Suraphong Phongsawad

摘要

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).