ABSTRACTS
Prehospital mechanical vs manual ventilation: A retrospective analysis of outcomes and vital signs in post-ROSC patientsAuthor: Andrew Grandin BS NRP CCP-C FP-C | Chief Executive Officer/Flight Paramedic | Grand Ideas Medical Consulting LLC/ ChristianaCare Associate Authors: Blizzard, Elizabeth BA NRP CCP-C FP-C Schwester, Caroline BS NREMT Bonczkowski, Nick BS NRP CCP-C FP-C Crowe, Remle, P PhD NREMT
Introduction: Effective ventilation following return of spontaneous circulation (ROSC) is critical to resuscitation success, yet optimal methods remain unclear. Manual ventilation with a bag-valve mask is highly operator-dependent, generating variability in delivered volumes, pressures, and rates, while prehospital mechanical ventilation remains less common. Our objective was to compare patient outcomes and vital sign parameters by mechanical or manual ventilation in post-ROSC cardiac arrest patients. Methods: We performed a retrospective analysis using the 2023 ESO Data Collaborative . We included patients who experienced out-of-hospital cardiac arrest before EMS arrival, had an initial shockable rhythm, achieved ROSC, and had a documented ROSC time. We excluded patients with traumatic arrest and patients with mechanical ventilation applied before ROSC. Our primary exposure was mechanical versus manual ventilation only. We compared the primary outcomes of survival to admission and survival to discharge by ventilation type using Chi-square tests. We further used Wilcoxon rank sum tests to compare post-ROSC values for oxygen saturation (SpO ₂), end tidal carbon dioxide (EtCO2), respiratory rate (RR), and shock index (SI). Lastly we used Chi-square tests to compare occurrence of rearrest and tension pneumothorax. Results: Out of 12,146,094 records, 2,897 met inclusion criteria. Among these 178 (6%) patients received prehospital mechanical ventilation. There were no significant differences in patient demographics, presenting rhythm, arrest etiology, vasopressor usage, or transport mode between groups. Median time to ROSC was approximately five minutes shorter in the mechanical ventilation group (12.4 min, IQR: 7.8-17.6 min) compared to the BVM only group (17.0 min, IQR:11.1-24.8 min; p<0.001). Although median values for SpO2, EtCO2, RR, and SI did not differ significantly between groups, the mechanical ventilation group showed substantially less variability. There was no significant difference in rearrest or tension pneumothorax rates between groups. The mechanical ventilation group showed marginally statistically significant increases in both survival to admission (85.7% versus 75.1%, p=0.047) and survival to discharge (44% versus 32.5%, p=0.045). Conclusion: These results suggest that patients who receive mechanical ventilation after ROSC have decreased variability in vital signs and improved survival to admission and discharge. Limitations include the small sample of patients in the mechanical ventilation group and reliance on retrospective data.
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