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World Journal of Emergency Medicine

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Effect of bag valve ventilation versus mechanical ventilation after endotracheal intubation during cardiopulmonary resuscitation on outcomes following out-of-hospital cardiac arrest: a propensity score analysis

Young Min Kim1,2, Hyun Seok Chai1,2, Gwan Jin Park1,2, Sang Chul Kim1,2, Hoon Kim1,2, Seok Woo Lee1,2, Hyeon Jeong Park2, Han Bit Kim3, Hyo Been Lee4, Ji Han Lee2,5   

  1. 1Department of Emergency Medicine, Chungbuk National University Hospital, Cheong-ju 28644, Republic of Korea
    2Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju 28644, Republic of Korea
    3Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Republic of Korea
    4Healthcare Big Data Center, Research Institute of Clinical Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
    5Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si 11765, Republic of Korea
  • Received:2024-07-29 Accepted:2024-12-24
  • Contact: Ji Han Lee, E-mail:capcloud80@hanmail.net

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Abstract: BACKGROUND: In this study, we aimed to evaluate the impact of mechanical ventilator (MV) use during cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patient clinical outcomes in the emergency department.

METHODS: This single-centered, retrospective, case-control study analyzed electronic medical records. Patients aged >18 years with non-traumatic OHCA who were treated at an emergency medical center between January 2019 and December 2023 were included. These patients were accessed according to the ventilatory method used: MV ventilation (volume control, tidal volume 6–8 mL/kg, frequency 10 bpm, inspiratory time 1 s) and manual resuscitator bag valve (BV) ventilation. The primary outcome was the return of spontaneous circulation (ROSC). After 1:1 propensity score matching, the clinical outcomes were analyzed.

RESULTS: In total, 649 patients were enrolled in this study. Before matching, the clinical outcomes and pneumothorax incidence did not differ between the MV and BV groups. After 1:1 matching between the two groups using propensity scores, 522 patients (261 MV and 261 BV) were analyzed. Propensity score matching yielded an adequate balance (standardized mean difference <0.10) for all covariates. The estimated odds ratio for ROSC was 1.23 (95% confidence interval [CI]: 0.85–1.77; P=0.267), whereas the odds ratio (OR) for survival at hospital discharge was 2.31 (95% CI:1.10–5.20; P=0.033), indicating a benefit in the MV group for that outcome.

CONCLUSION: In patients with OHCA admitted to the emergency department, MV ventilation during CPR showed clinical outcomes similar to those of BV ventilation in most measures. However, survival at hospital discharge was significantly higher in the MV group, suggesting potential benefits of MV use in selected patients.


Key words: Cardiac arrest, Mechanical ventilation, Bag valve ventilation