Mechanical ventilation vs bag-valve ventilation during cardiopulmonary resuscitation: a randomized crossover noninferiority trial
- 1Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry 605006, India
Abstract
Aim: Evidence guiding mechanical ventilation (MV) during CPR is limited, and device-calculated inspired tidal volume (VTi) during ongoing chest compressions may differ from the set volume during compressions. We compared VTi with protocolized MV and bag-valve ventilation (BVV) through an endotracheal tube for noninferiority.
Methods: This single-center randomized crossover noninferiority trial enrolled 104 intubated adults meeting termination-of-resuscitation criteria without return of spontaneous circulation to receive BVV and MV in randomized order within a 5-min peri-termination window. Device-calculated VTi was recorded for 1 min per method during ongoing compressions. The primary outcome was the between-treatment difference in per-participant median VTi; the noninferiority margin was −150 mL (MV minus BVV).
Results: Among 99 participants completing both periods, mean per-participant median VTi was 514.4 mL with BVV and 368.0 mL with MV; coefficients of variation were 40.1% and 28.3%. The adjusted mean difference was −146.2 mL (95% CI, −187.0 to −105.5). Because the lower bound crossed −150 mL, noninferiority was not demonstrated. Median VTi exceeded 10 mL/kg predicted body weight in 31.3% with BVV and 0% with MV, whereas values below 6 mL/kg occurred in 26.3% and 45.5%.
Conclusions: Protocolized MV produced lower and less variable device-calculated VTi than BVV but did not meet noninferiority. BVV had a wider upper tail, whereas MV more often produced values below 6 mL/kg. The unvalidated analyzer and absence of clinical outcomes limit interpretation.
Clinical trial registration: Clinical Trials Registry − India; CTRI/2024/08/072738.
Related
- Transport mechanical ventilation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: an exploratory prehospital pilot study
- Positive end-expiratory pressure versus sham valve/zero end-expiratory pressure in cardiopulmonary resuscitation during manual ventilation toimprove neurological outcomes in adult patients suffering an out-of-hospital cardiac arrest - an investigator-initiated, pragmatic, registry-based, multicenter, parallel-group, triple-blind randomized controlled superiority clinical trial in the ARREST registry (REVIVE-PEEP protocol Stage-1 Registered Report)
- Efficacy and safety of mechanical chest compression compared with manual cardiopulmonary resuscitation in adult non-traumatic cardiac arrest: a systematic review of the literature
- Mechanical Cardiopulmonary Resuscitation - Assisted Percutaneous Coronary Intervention during Cardiac Arrest: Feasibility and Outcomes.
- Design and protocol of a randomized assessor-blinded controlled trial evaluating an educational escape room for individual and team cardiopulmonary resuscitation skills among nursing students
BibTeX
@article{vinay2026mechanical,
title = {{Mechanical ventilation vs bag-valve ventilation during cardiopulmonary resuscitation: a randomized crossover noninferiority trial}},
author = {S. Vinay and S. Manu Ayyan and V.T. Amrithanand and B.G. Kowsthubha},
journal = {Resuscitation Plus},
year = {2026},
month = oct,
doi = {10.1016/j.resplu.2026.101530},
url = {https://doi.org/10.1016/j.resplu.2026.101530},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Mechanical ventilation vs bag-valve ventilation during cardiopulmonary resuscitation: a randomized crossover noninferiority trial
AU - S. Vinay
AU - S. Manu Ayyan
AU - V.T. Amrithanand
AU - B.G. Kowsthubha
PY - 2026
DA - 2026/10/13
JO - Resuscitation Plus
DO - 10.1016/j.resplu.2026.101530
UR - https://doi.org/10.1016/j.resplu.2026.101530
AB - Aim: Evidence guiding mechanical ventilation (MV) during CPR is limited, and device-calculated inspired tidal volume (VTi) during ongoing chest compressions may differ from the set volume during compressions. We compared VTi with protocolized MV and bag-valve ventilation (BVV) through an endotracheal tube for noninferiority. Methods: This single-center randomized crossover noninferiority trial enrolled 104 intubated adults meeting termination-of-resuscitation criteria without return of spontaneous circulation to receive BVV and MV in randomized order within a 5-min peri-termination window. Device-calculated VTi was recorded for 1 min per method during ongoing compressions. The primary outcome was the between-treatment difference in per-participant median VTi; the noninferiority margin was −150 mL (MV minus BVV). Results: Among 99 participants completing both periods, mean per-participant median VTi was 514.4 mL with BVV and 368.0 mL with MV; coefficients of variation were 40.1% and 28.3%. The adjusted mean difference was −146.2 mL (95% CI, −187.0 to −105.5). Because the lower bound crossed −150 mL, noninferiority was not demonstrated. Median VTi exceeded 10 mL/kg predicted body weight in 31.3% with BVV and 0% with MV, whereas values below 6 mL/kg occurred in 26.3% and 45.5%. Conclusions: Protocolized MV produced lower and less variable device-calculated VTi than BVV but did not meet noninferiority. BVV had a wider upper tail, whereas MV more often produced values below 6 mL/kg. The unvalidated analyzer and absence of clinical outcomes limit interpretation. Clinical trial registration: Clinical Trials Registry − India; CTRI/2024/08/072738.
SN - 2666-5204
ER -