Transport mechanical ventilation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: an exploratory prehospital pilot study
- 1Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand
- 2Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, Thailand
Abstract
Background: Evidence regarding the use of mechanical ventilation (MV) during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) remains limited, particularly in prehospital settings.
Objective: To evaluate the feasibility and generate preliminary physiologic data regarding transport MV compared with bag-valve ventilation (BV) during CPR in OHCA.
Methods: This prospective, time-sequenced, exploratory pilot study, conducted between September 2024 and October 2025, included adult OHCA patients aged ≥ 18 years managed by the Ramathibodi Emergency Medical Operation team. Patients received BV during the first 6 months, followed by MV thereafter, delivered using a HAMILTON-T1 transport mechanical ventilator in volume-controlled mode (tidal volume: 6–8 mL/kg; respiratory rate: 10 breaths/min; PEEP: 0 cmH₂O; I:E ratio: 1:5; FiO₂: 1.0; flow trigger: off). Ventilation was assessed using arterial or venous PCO₂ obtained after ≥ 3 min following intubation or upon return of spontaneous circulation (ROSC). As a pilot study, this investigation was not powered to detect differences in clinical outcomes.
Results: Forty-one patients were analysed (29 BV, 12 MV). The mean age was 67 ± 15 years in the BV group and 66 ± 20 years in the MV group, with 55.2% and 66.7% male patients, respectively. No statistically significant differences were detected in PCO₂, pH, or pO₂ between groups. Clinical outcomes, including sustained ROSC and 28-day survival, were also similar between groups. Mechanical ventilation was operationally feasible in the prehospital setting despite several implementation challenges.
Conclusion: In this exploratory prehospital pilot study, MV during CPR was feasible and produced preliminary physiologic measures comparable to BV. These findings are hypothesis-generating and may inform the design of future adequately powered studies.
Trial registration: The study protocol was registered with the Thai Clinical Trials Registry (TCTR20241008007; 08 October 2024).
Related
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- 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.
- 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)
BibTeX
@article{tienpratarn2026transport,
title = {{Transport mechanical ventilation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: an exploratory prehospital pilot study}},
author = {Welawat Tienpratarn and Pariyakon Kusolthammarat and Chaiyaporn Yuksen and Suraphong Phongsawad},
journal = {BMC Emergency Medicine},
year = {2026},
month = jul,
doi = {10.1186/s12873-026-01692-8},
url = {https://doi.org/10.1186/s12873-026-01692-8},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Transport mechanical ventilation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest: an exploratory prehospital pilot study
AU - Welawat Tienpratarn
AU - Pariyakon Kusolthammarat
AU - Chaiyaporn Yuksen
AU - Suraphong Phongsawad
PY - 2026
DA - 2026/07/29
JO - BMC Emergency Medicine
DO - 10.1186/s12873-026-01692-8
UR - https://doi.org/10.1186/s12873-026-01692-8
AB - Background: Evidence regarding the use of mechanical ventilation (MV) during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) remains limited, particularly in prehospital settings. Objective: To evaluate the feasibility and generate preliminary physiologic data regarding transport MV compared with bag-valve ventilation (BV) during CPR in OHCA. Methods: This prospective, time-sequenced, exploratory pilot study, conducted between September 2024 and October 2025, included adult OHCA patients aged ≥ 18 years managed by the Ramathibodi Emergency Medical Operation team. Patients received BV during the first 6 months, followed by MV thereafter, delivered using a HAMILTON-T1 transport mechanical ventilator in volume-controlled mode (tidal volume: 6–8 mL/kg; respiratory rate: 10 breaths/min; PEEP: 0 cmH₂O; I:E ratio: 1:5; FiO₂: 1.0; flow trigger: off). Ventilation was assessed using arterial or venous PCO₂ obtained after ≥ 3 min following intubation or upon return of spontaneous circulation (ROSC). As a pilot study, this investigation was not powered to detect differences in clinical outcomes. Results: Forty-one patients were analysed (29 BV, 12 MV). The mean age was 67 ± 15 years in the BV group and 66 ± 20 years in the MV group, with 55.2% and 66.7% male patients, respectively. No statistically significant differences were detected in PCO₂, pH, or pO₂ between groups. Clinical outcomes, including sustained ROSC and 28-day survival, were also similar between groups. Mechanical ventilation was operationally feasible in the prehospital setting despite several implementation challenges. Conclusion: In this exploratory prehospital pilot study, MV during CPR was feasible and produced preliminary physiologic measures comparable to BV. These findings are hypothesis-generating and may inform the design of future adequately powered studies. Trial registration: The study protocol was registered with the Thai Clinical Trials Registry (TCTR20241008007; 08 October 2024).
SN - 1471-227X
ER -