SBMU Journals
  • New Submission
  • Register
  • Login
  • English
    • 简体中文

Archives of Academic Emergency Medicine

  • Home
  • About
    • Policies
    • Editorial Team
    • Reviewer guideline
    • Contact
  • Issues
    • Current
    • Archives
  • Announcements
  • Indexing/Abstracting
  • For authors
    • New Submission
    • Author guidelines
    • Article withdrawal
    • Peer review process
    • FAQ
  • Ethics
    • Ethical requirements
    • Plagiarism Policy
    • Authorship conflicts
    • Malpractice statements
    • Copyright Notice
    • Intellectual properties
    • Preprint Policy
    • Privacy Statement
    • Artificial intelligence & Authorship
    • Retraction Cosiderations
Advanced Search
  1. Home
  2. Archives
  3. Vol. 13 No. 1 (2025): Continuous volume
  4. Original/Research Article

Vol. 13 No. 1 (2025)

September 2025

Manual vs. Mechanical Ventilation in Respiratory Parameters of intubated Patients During cardiopulmonary Resuscitation; a Randomized Clinical Trial

  • Nastaran Lotfi
  • Ahmad Bagheri Moghaddam
  • Razieh Froutan
  • Hossein Nezami

Archives of Academic Emergency Medicine, Vol. 13 No. 1 (2025), 6 September 2025 , Page e48
https://doi.org/10.22037/aaemj.v13i1.2652 Published: 2025-05-22

  • View Article
  • Download
  • Cite
  • References
  • Statastics
  • Share

Abstract

Introduction: Ventilation and oxygen delivery during cardiopulmonary resuscitation (CPR) is of paramount importance. This study aimed to compare the effects of manual and mechanical ventilation on respiratory parameters of intubated patients during CPR. Methods: This randomized controlled clinical trial was conducted in 2024 on 61 intubated patients with neurological disorders admitted to the ICU of educational hospitals. Participants were allocated to either the intervention or the control group using block randomization with a block size of six. The intervention group received mechanical ventilation, while the control group received manual ventilation using bag valve mask (BVM). The effects of manual versus mechanical ventilation during CPR on key physiological and respiratory parameters, including venous blood gases (VBG), end tidal Co2 (ETCO₂), and peripheral oxygen saturation (SpO₂) were compared between groups. Statistical analyses were performed using SPSS version 21.

Results: The study findings indicated no statistically significant differences between the manual and mechanical ventilation groups in terms of venous blood pH levels (P = 0.38), PCO2 (P = 0.65), and HCO3 levels (P = 0.47) changes. However, PO₂ (P < 0.001), ETCO₂ (P < 0.05). and SpO₂ (P < 0.001) were more stable and consistently higher in patients receiving mechanical ventilation.

Conclusion: These findings suggest that while pH, PCO₂, and HCO3 levels did not significantly differ between the two ventilation methods, mechanical ventilation demonstrated superior efficacy in optimizing oxygenation (PO₂ and SpO₂) and regulating ETCO₂ levels.

Keywords:
  • Cardiopulmonary resuscitation
  • venous blood gases
  • Ventilation
  • Blood Gas Analysis
  • Carbon Dioxide
  • Oxygen Saturation
  • pdf

How to Cite

1.
Lotfi N, Bagheri Moghaddam A, Froutan R, Nezami H. Manual vs. Mechanical Ventilation in Respiratory Parameters of intubated Patients During cardiopulmonary Resuscitation; a Randomized Clinical Trial. Arch Acad Emerg Med [Internet]. 2025 May 22 [cited 2026 Jul. 7];13(1):e48. Available from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2652
  • ACM
  • ACS
  • APA
  • ABNT
  • Chicago
  • Harvard
  • IEEE
  • MLA
  • Turabian
  • Vancouver
  • Endnote/Zotero/Mendeley (RIS)
  • BibTeX

References

Gu W, Li C-S. Ventilation strategies during out-of-hospital cardiac arrest: a problem that should not be neglected. J Emerg Crit Care Med. 2017;1(9) :Art. 9.

Chen K-Y, Ko Y-C, Hsieh M-J, Chiang W-C, Ma MH-M. Interventions to improve the quality of bystander cardiopulmonary resuscitation: A systematic review. PLOS ONE. 2019;14(2):e0211792.

Zheng K, Du L, Cao Y, Niu Z, Song Z, Liu Z, et al. Monitoring cardiopulmonary resuscitation quality in emergency departments: a national survey in China on current knowledge, attitudes, and practices. BMC Emerg Med. 2022;22(1):33.

Kill C, Dersch W, Wulf H. Advanced life support and mechanical ventilation. Curr Opin Crit Care. 2012;18(3):251-5.

Liu Y-c, Qi Y-m, Zhang H, Walline J, Zhu H-d. A survey of ventilation strategies during cardiopulmonary resuscitation. World J Emerg Med. 2019;10(4):222.

Sahu AK, Timilsina G, Mathew R, Jamshed N, Aggarwal P. “Six-dial Strategy”—Mechanical Ventilation during Cardiopulmonary Resuscitation. Indian J Crit Care Med. 2020;24(6):487.

Neth MR, Idris A, McMullan J, Benoit JL, Daya MR. A review of ventilation in adult out‐of‐hospital cardiac arrest. JACEP Open. 2020;1(3):190-201.

Ruemmler R, Ziebart A, Moellmann C, Garcia-Bardon A, Kamuf J, Kuropka F, et al. Ultra-low tidal volume ventilation—A novel and effective ventilation strategy during experimental cardiopulmonary resuscitation. Resuscitation. 2018;132:56-62.

Johannigman JA, Branson RD, Johnson DJ, Davis Jr K, Hurst JM. Out‐of‐hospital Ventilation: Bag‐Valve Device vs Transport Ventilator. Acad Emerg Med. 1995;2(8):719-24.

Broc A, Morin F, Schmit H, Taillantou-Candau M, Vuillermoz A, Drouet A, et al. Performances and limits of Bag-Valve-Device for pre-oxygenation and manual ventilation: A comparative bench and cadaver study. Resuscitation. 2023:109999.

Noordergraaf GJ, Van Dun PJ, Schors MP, De Jong W, Noordergraaf A. Efficacy and safety in patients on a resuscitator, Oxylator EM-100, in comparison with a bag-valve device. Am J Emerg Med. 2004;22(7):537-43.

Senthilnathan M, Ravi R, Suganya S, Sivakumar RK. Manual vs. mechanical ventilation in patients with advanced airway during CPR. Indian Heart J. 2022;74(5):428-9.

Cordioli RL, Brochard L, Suppan L, Lyazidi A, Templier F, Khoury A, et al. How ventilation is delivered during cardiopulmonary resuscitation: an international survey. Respir Care. 2018;63(10):1293-301.

Wu M, Zhang X, Jiang Y, Guo Y, Zhang W, He H, et al. Comparison of clinical outcomes in critical patients undergoing different mechanical ventilation modes: a systematic review and network meta-analysis. Front Med. 2023;10:Art. 110000.

Tan D, Xu J, Shao S, Fu Y, Sun F, Zhang Y, et al. Comparison of different inspiratory triggering settings in automated ventilators during cardiopulmonary resuscitation in a porcine model. PLOS ONE. 2017;12(2):e0171869.

Neumamm LBA, Jardim-Neto AC, Motta-Ribeiro GC. Empirical evidence for safety of mechanical ventilation during simulated cardiopulmonary resuscitation on a physical model. Am J Emerg Med. 2021;48:312-5.

Abraldes JA, Fernandes RJ, Rodríguez N, Sousa A. Is rescuer cardiopulmonary resuscitation jeopardised by previous fatiguing exercise? Int J Environ Res Public Health. 2020;17(18):6668.

Hong S-I, Kim J-S, Kim Y-J, Kim WY. Dynamic changes in arterial blood gas during cardiopulmonary resuscitation in out-of-hospital cardiac arrest. Sci Rep. 2021;11(1):23165.

Kim Y-J, Lee YJ, Ryoo SM, Sohn CH, Ahn S, Seo D-W, et al. Role of blood gas analysis during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients. Medicine (Baltimore). 2016;95(25). e4023.

Orso D, Vetrugno L, Federici N, Borselli M, Spadaro S, Cammarota G, et al. Mechanical ventilation management during mechanical chest compressions. Respir Care. 2021;66(2):334-46.

Tangpaisarn T, Tosibphanom J, Sata R, Kotruchin P, Drumheller B, Phungoen P. The effects of mechanical versus bag-valve ventilation on gas exchange during cardiopulmonary resuscitation in emergency department patients: A randomized controlled trial (CPR-VENT). Resuscitation. 2023;193:109966.

Hong S, Jang JH, Yang JH, Cho YH, Ahn J, Ryu JA. Optimal arterial blood gas tensions for the prognosis of favorable neurological outcomes in survivors after extracorporeal cardiopulmonary resuscitation. J Clin Med. 2022;11(14):4211.

Patel JK, Schoenfeld E, Parikh PB, Parnia S. Association of arterial oxygen tension during in-hospital cardiac arrest with return of spontaneous circulation and survival. J Intensive Care Med. 2018;33(7):407-14.

Spindelboeck W, Gemes G, Strasser C, Toescher K, Kores B, Metnitz P, et al. Arterial blood gases during and their dynamic changes after cardiopulmonary resuscitation: a prospective clinical study. Resuscitation. 2016;106:24-9.

Xu J, Li C, Tang H, Tan D, Fu Y, Zong L, et al. Pulse oximetry waveform: A non-invasive physiological predictor for the return of spontaneous circulation in cardiac arrest patients----A multicenter, prospective observational study. Resuscitation. 2021;169:189-97.

Crickmer M, Drennan IR, Turner L, Cheskes S. The association between end-tidal CO2 and return of spontaneous circulation after out-of-hospital cardiac arrest with pulseless electrical activity. Resuscitation. 2021;167:76-81.

Hambelton C, Wu L, Smith J, Thompson K, Neth MR, Daya MR, et al. Utility of end-tidal carbon dioxide to guide resuscitation termination in prolonged out-of-hospital cardiac arrest. Am J Emerg Med. 2024;77:77-80.

Baldi E, Caputo ML, Klersy C, Benvenuti C, Contri E, Palo A, et al. End-tidal carbon dioxide (ETCO2) at intubation and its increase after 10 minutes resuscitation predicts survival with good neurological outcome in out-of-hospital cardiac arrest patients. Resuscitation. 2022;181:197-207.

Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004;32(9):S345-S51.

de Gauna SR, Gutiérrez JJ, Ruiz J, Leturiondo M, Azcarate I, González-Otero DM, et al. The impact of ventilation rate on end-tidal carbon dioxide level during manual cardiopulmonary resuscitation. Resuscitation. 2020;156:215-22.

Ahn HJ, Kim KD, Jeong WJ, Lee JW, Yoo IS, Ryu S. The adequacy of a conventional mechanical ventilator as a ventilation method during cardiopulmonary resuscitation: a manikin study. Korean J Crit Care Med. 2015;30(2):89-94.

Fuest K, Dorfhuber F, Lorenz M, von Dincklage F, Mörgeli R, Kuhn KF, et al. Comparison of volume-controlled, pressure-controlled, and chest compression-induced ventilation during cardiopulmonary resuscitation with an automated mechanical chest compression device: A randomized clinical pilot study. Resuscitation. 2021;166:85-92.

Orlob S, Wittig J, Hobisch C, Auinger D, Honnef G, Fellinger T, et al. Reliability of mechanical ventilation during continuous chest compressions: a crossover study of transport ventilators in a human cadaver model of CPR. Scand J Trauma Resusc Emerg Med. 2021;29:1-9:Art. 123.

Kolstad V, Pike H, Eilevstjønn J, Buskov F, Ersdal H, Rettedal S. Use of Pulse Oximetry during Resuscitation of 230 Newborns- A Video Analysis. Children (Basel). 2023;10(7):1124.

R. C. Air/oxygen blenders and pulse oximetry in resuscitation at birth: London: Resuscitation Council UK (RCUK); 2011 URL: https://www.resus.org.uk

Hassan MA, Mendler M, Maurer M, Waitz M, Huang L, Hummler HD. Reliability of pulse oximetry during cardiopulmonary resuscitation in a piglet model of neonatal cardiac arrest. Neonatology. 2015;107(2):113-9.

Dogan B, Kudu E, Danış F, Ozturk Ince E, Karaca MA, Erbil B. Comparative Analysis of Perfusion Index and End-Tidal Carbon Dioxide in Cardiac Arrest Patients: Implications for Hemodynamic Monitoring and Resuscitation Outcomes. Cureus. 2023;15(12):e50818.

  • Abstract Viewed: 430 times
  • pdf Downloaded: 882 times

Download Statastics

  • Linkedin
  • Twitter
  • Facebook
  • Google Plus
  • Telegram

Make a Submission

Make a Submission

SJR

SCImago Journal & Country Rank

COPE

Current Issue

  • Atom logo
  • RSS2 logo
  • RSS1 logo

Information

  • For Readers
  • For Authors
  • For Librarians
  • Home
  • Archives
  • Submissions
  • About the Journal
  • Editorial Team
  • Contact

This journal is distributed under the terms of CC BY-NC 3.0. Design and publishing by SBMU journals. All credits and honors to PKP for their OJS. 

 Sitemap | ISSN-ONLINE: 2645-4904

Support Contact: ma.saghaei63@gmail.com

With the goal of net zero carbon emissions, this journal is published only in electronic format.

Powered by OJSPlus