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Alberto Hernández-Tejedor1, Vanesa González Puebla1, Jorge Duerto Álvarez2, Sandra Ofelia Rosillo Rodríguez3, María Jiménez Lapastora4, Sara Casanova Prieto5, Aaron Blandino Ortiz6, Hans Paul Gaebelt Slocker7, Manuel Quintana Díaz3, Emilia Rosas Carvajal8
Objective.
This analysis evaluates respiratory outcomes and the occurrence of respiratory complications during the first 24 hours after hospital admission, according to the ventilatory strategy used during out-of-hospital cardiopulmonary resuscitation, including a group with a ventilatory mode synchronized with chest compressions.
Method.
Pragmatic quasi-experimental study including all patients with out of hospital cardiac arrest with persistence of cardiac arrest 3 minutes after early intubation who were transferred to a hospital. Duration: 3.5 years. Patients were grouped according to ventilation strategy: Chest Compression Synchronized Ventilation (CCSV), Intermittent Positive Pressure Ventilation (IPPV), or bag-valve ventilation. Radiological findings (pneumothorax, signs of barotrauma, and pulmonary infiltrates according to the Modified Chest X-ray Scoring System) and arterial blood gas parameters within the first 24 hours after hospital admission were analyzed.
Results.
A total of 278 patients transferred to a hospital were included, and 68 were excluded because no radiological study was performed due to immediate certification of death (22.7% women, mean age 61.9 (SD, 16.5) years, 44.3% with shockable rhythm): 41 in the CCSV group, 65 in the IPPV group, and 104 with bag-valve ventilation. PaO2/FiO2 values were, respectively, 247 (SD, 162), 200 (SD, 117), and 202 (SD, 118) mmHg (P < .05 between CCSV and the other groups). Pneumothorax or subcutaneous emphysema was found in 2.4% of patients ventilated with CCSV, 10.8% with IPPV, and 6.7% with bag-valve ventilation (P = .26). The Modified Chest X-ray Score was, respectively, 4.6 (SD, 3.1), 5.7 (SD, 3.3), and 5.1 (SD, 3.1) (P = .23).
Conclusions.
CCSV is associated with better PaO2/FiO2 at 24 hours vs other ventilation strategies. There was no higher incidence rate of pneumothorax with CCSV, and no significant differences were found in the development of radiological infiltrates.
