Volume-controlled mechanical ventilation during cardiopulmonary resuscitation: a systematic review and meta-analysis

To assess the evidence on volume-controlled mechanical ventilation versus manual ventilation or other ventilation modes during cardiopulmonary resuscitation (CPR).

On 18 March 2026, we searched PubMed, Embase, and Web of Science (PROSPERO: CRD420251110999). Randomized trials and non-randomized studies in children or adults with cardiac arrest and an advanced airway were included. Risk of bias was assessed using RoB2 and ROBINS-I tools. Meta-analyses were performed when appropriate, and certainty of evidence was assessed using GRADE.

We screened 12,004 abstracts and included 13 articles consisting of six trials enrolling 461 patients and seven non-randomized studies including 4607 patients. No study reported data on children. Meta-analysis of 120 patients from two randomized trials comparing volume-controlled to manual ventilation showed no difference for return of spontaneous circulation (ROSC) (odds ratio, 1.31; 95%-confidence interval, 0.64-2.71). Comparisons to pressure-controlled and CPR-specific modes were limited to a single trial each, with uncertain results. Randomized trials were at low to high risk of bias. Non-randomized studies were at serious or critical risk of bias. The certainty of evidence was very low to low across comparisons.

Very low to low certainty evidence from randomized trials suggests no significant difference in clinical outcomes between volume-controlled mechanical ventilation and manual ventilation. The relative effectiveness of volume-controlled ventilation compared to other mechanical ventilation modes is uncertain.