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A retrospective comparison of mechanical cardio-pulmonary ventilation and manual bag valve ventilation in non-traumatic out-of-hospital cardiac arrests: A study from the Belgian cardiac arrest registry
Resuscitation ( IF 6.5 ) Pub Date : 2024-04-04 , DOI: 10.1016/j.resuscitation.2024.110203
Stefano Malinverni , Stéphan Wilmin , Diane de Longueville , Mathilde Sarnelli , Griet Vermeulen , Mahmoud Kaabour , Marc Van Nuffelen , Ives Hubloue , Simon Scheyltjens , Alessandro Manara , Pierre Mols , Jean-Christophe Richard , Francis Desmet

The optimal ventilation modalities to manage out-of-hospital cardiac arrest (OHCA) remain debated. A specific pressure mode called cardio-pulmonary ventilation (CPV) may be used instead of manual bag ventilation (MBV). We sought to analyse the association between mechanical CPV and return of spontaneous circulation (ROSC) in non-traumatic OHCA. MBV and CPV were retrospectively identified in patients with non-traumatic OHCA from the Belgian Cardiac Arrest Registry. We used a two-level mixed-effects multivariable logistic regression analysis to determine the association between the ventilation modalities and outcomes. The primary and secondary study criteria were ROSC and survival with a Cerebral Performance Category (CPC) score of 1 or 2 at 30 days. Age, sex, initial rhythm, no-flow duration, low-flow duration, OHCA location, use of a mechanical chest compression device and Rankin status before arrest were used as covariables. Between January 2017 and December 2021, 2566 patients with OHCA who fulfilled the inclusion criteria were included. 298 (11.6%) patients were mechanically ventilated with CPV whereas 2268 were manually ventilated. The use of CPV was associated with greater probability of ROSC both in the unadjusted (odds ratio: 1.28, 95% confidence interval [CI]: 1.01–1.63; = 0.043) and adjusted analyses (adjusted odds ratio [aOR]: 2.16, 95%CI 1.37–3.41; = 0.001) but not with a lower CPC score (aOR: 1.44, 95%CI 0.72–2.89; = 0.31). Compared with MBV, CPV was associated with an increased risk of ROSC but not with improved an CPC score in patients with OHCA. Prospective randomised trials are needed to challenge these results.

中文翻译:

非创伤性院外心脏骤停中机械心肺通气和手动袋阀通气的回顾性比较:比利时心脏骤停登记处的一项研究

处理院外心脏骤停 (OHCA) 的最佳通气方式仍存在争议。可以使用称为心肺通气 (CPV) 的特定压力模式来代替手动袋通气 (MBV)。我们试图分析非创伤性 OHCA 中机械 CPV 与自主循环恢复 (ROSC) 之间的关联。在比利时心脏骤停登记处的非创伤性 OHCA 患者中回顾性鉴定了 MBV 和 CPV。我们使用两级混合效应多变量逻辑回归分析来确定通气方式和结果之间的关联。主要和次要研究标准是 ROSC 和 30 天时大脑表现类别 (CPC) 评分为 1 或 2 的存活率。年龄、性别、初始节律、无流量持续时间、低流量持续时间、OHCA 位置、机械胸外按压装置的使用以及逮捕前的 Rankin 状态被用作协变量。 2017 年 1 月至 2021 年 12 月期间,纳入了 2566 名符合纳入标准的 OHCA 患者。 298 名患者 (11.6%) 接受 CPV 机械通气,而 2268 名患者接受手动通气。在未调整(比值比:1.28,95% 置信区间 [CI]:1.01–1.63;= 0.043)和调整分析(调整后比值比 [aOR]:2.16,95)中,CPV 的使用与 ROSC 的更大概率相关。 %CI 1.37–3.41;= 0.001),但 CPC 得分较低(aOR:1.44,95%CI 0.72–2.89;= 0.31)。与 MBV 相比,CPV 与 OHCA 患者 ROSC 风险增加相关,但与 CPC 评分改善无关。需要前瞻性随机试验来挑战这些结果。
更新日期:2024-04-04
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