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. 2025 May 22;13(1):e48.
doi: 10.22037/aaemj.v13i1.2652. eCollection 2025.

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

Nastaran Lotfi  1 , Ahmad Bagheri Moghaddam  2 , Razieh Froutan  3 , Hossein Nezami  4
Affiliations

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

Nastaran Lotfi et al. Arch Acad Emerg Med. .

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: Blood Gas Analysis; Carbon Dioxide; Cardiopulmonary resuscitation; Oxygen Saturation; Ventilation.

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Conflict of interest statement

The authors have no conflicts of interest to declare

Figures

Figure 1
Figure 1
The flowchart of study.
Figure 2
Figure 2
Respiratory parameters and perfusion index changes in patients who underwent manual and mechanical ventilation. ROSC: return of spontaneous circulation; PCO2: partial pressure of carbon dioxide; PO2: partial pressure of carbon dioxide; HCO3: Bicarbonate; ETCO2: End-tidal Carbon Dioxide; SpO2: Peripheral oxygen saturation.
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