Ventilatory parameters during emergency department-based CPR and exploratory associations with return of spontaneous...

Evidence guiding ventilation strategies during cardiopulmonary resuscitation (CPR) in humans remains limited, particularly in real-world emergency department (ED) settings. Existing recommendations are largely derived from animal studies and controlled environments, and how ventilation is delivered during ED-based CPR has not been well characterized.

This single-center prospective observational study described ventilation practices during ED-based CPR in adult patients with non-traumatic cardiac arrest who underwent endotracheal intubation. Minute ventilation, ventilation volume, and ventilation rate were measured using a flow sensor attached after ED arrival. Ventilatory parameters were summarized as patient-level averages during the recorded CPR period and compared between patients who achieved return of spontaneous circulation (ROSC) and those who did not. Multivariate logistic regression analysis was performed to explore potential associations with ROSC.

Among 100 included patients, 49 (49%) achieved ROSC. Median patient-average ventilation rate (19 [15-28] vs 18 [13-28] breaths/min; p = 0.35), ventilation volume (313 [263.5-416] vs 359 [300-428] ml; p = 0.48), and minute ventilation (7.2 [5.1-9.3] vs 6.7 [4.5-9.7] L/min; p = 0.91) were similar between ROSC and No ROSC groups. In exploratory multivariate analysis, minute ventilation within a moderate range of 5-8 L/min was associated with ROSC (adjusted odds ratio 2.52, 95%CI 1.03-6.15).

Ventilation practices during ED-based CPR showed substantial variability and frequently deviated from guideline-recommended targets. While exploratory analyses suggested a potential association between moderate minute ventilation and ROSC, these findings are descriptive and hypothesis-generating. Further studies with predefined ventilation targets and time-dependent analyses are required to clarify optimal ventilation strategies during CPR.