Bag-valve-endotracheal ventilation vs mechanical ventilation during cardiopulmonary resuscitation: a randomized...

The impact of ventilation strategy during cardiopulmonary resuscitation (CPR) on downstream cardio-cerebral injury remains uncertain.

Animals were randomized to bag-valve-endotracheal ventilation (BVE) or mechanical ventilation (MV) in a standardized porcine CPR model. Ventilator settings were predefined and held constant. MV (Oxylog 3000 plus) was delivered in a controlled mode (Vt 6-8 mL·kg^-1, RR 10/min, I:E 1:2, PEEP 0 cmH₂O, P _peak limit 40 cmH₂O) with triggers disabled. BVE used a 1.6 L self-inflating bag connected to the ETT with a 40 cmH₂O pop-off valve; RR was guided at 10/min with a metronome targeting I:E 1:2 and no PEEP. Biomarkers for cardiac and cerebral injury were sampled at baseline, after 4 min ventilation during CPR (post-Vent), at ROSC, and 24 h after ROSC (ROSC-24 h). We also compared hemodynamics, respiratory mechanics, oxidative-stress markers, inflammatory cytokines, and performed qualitative histology.

Compared with MV, BVE maintained lower mean airway and intrathoracic pressures (ITP), accompanied by more favorable perfusion and oxygen-metabolic profiles. BVE was associated with less severe myocardial and neuronal ultrastructural injury.

In this prolonged porcine CPR model, BVE with real-time monitoring reduced ITP burden, improved hemodynamic and oxygen-metabolic profiles, and decreased markers of cardiac and cerebral injury compared with a conservatively configured MV strategy, suggesting that ventilation delivery may determine organ protection; however, these findings require confirmation in larger translational and clinical studies.