The Effects of Ventilation During Cardiopulmonary Resuscitation Using Manual Bag-Valve or Mechanical Ventilator on the Return of Spontaneous Circulation and Lactate Levels

Year 2024, Volume: 9 Issue: 3, 107 - 113, 31.12.2024

Güven Yılmaz , Burcu Azapoğlu Kaymak , Tuba Cimilli , Emre Yılmaz , Serhat Ersöz , Mustafa Çalık

https://doi.org/10.55694/jamer.1554074

Abstract

Aim: The aim is to investigate the effect of manual ventilation using a bag-valve versus mechanical ventilation on the return of
spontaneous circulation and the progression of lactate levels during cardiopulmonary resuscitation.
Materials and Methods: The study was conducted at the Emergency Medicine Department of Fatih Sultan Mehmet Training and
Research Hospital, between January 4, 2019, and January 4, 2021, following ethical approval. It was designed as a prospective,
randomized study. Advanced cardiac life support was administered to patients who presented with cardiac arrest. The patients
were randomized into two groups, with 15 patients included in each group. The resuscitation team provided manual ventilation
with a bag-valve for one group and mechanical ventilation in ‘CPR mode’ for the other group. Lactate levels at 0, 5, 10, 15, and
20 minutes during the intervention, as well as the duration of return of spontaneous circulation, if achieved, were recorded and
compared between the groups.
Results: The mean age of the patients was 47.8, with 16 male and 14 female patients. CPR was applied for a minimum of
20 minutes. Return of spontaneous circulation (ROSC) was achieved in 4 patients. Lactate levels showed a decrease in the
mechanical ventilator group, while an increasing trend was observed in the bag-valve manual ventilation group. There was no
significant difference between the groups regarding the effect of the ventilation method on the return of spontaneous circulation
(p > 0.05).
Conclusion: It was observed that the use of a mechanical ventilator instead of manual bag-valve ventilation did not negatively
affect the return of spontaneous circulation. Furthermore, a tendency for lactate levels to decrease was noted in the mechanical
ventilation group compared to the bag-valve manual ventilation group.

Keywords

Advanced Airway, Ventilation, Mechanical ventilation during CPR, bag-valve ventilation

Kardiyopulmoner Resüsitasyon Sırasında Ventilasyonun Manuel Balon-Valf Veya Mekanik Ventilatör İle Sağlanmasının Spontan Dolaşımın Geri Dönüşü Ve Laktat Düzeyi Üzerine Etkisi

Abstract

Amaç: Kardiyopulmoner resüsitasyon sırasında balon-valf ile manuel olarak uygulanan ventilasyon ile mekanik ventilatör
aracılığıyla uygulanan ventilasyonun spontan dolaşımın geri dönüşü ve laktat düzeyinin seyri üzerine etkisini araştırmaktır.
Gereç ve Yöntemler: Çalışma; Sağlık Bilimleri Üniversitesi İstanbul Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi
Acil Tıp Kliniği’nde 04.01.2019 ile 04.01.2021 tarihleri arasında etik kurul onayı alınmasını takiben yürütüldü. Prospektif,
randomize olarak tasarlanan çalışma kliniğimize gelen kardiyak arrest hastalar üzerinde yapıldı. Kardiyak arrest olarak gelen
hastalara Güncel American Heart Association İleri Kardiyak Yaşam Desteği algoritmasına uygun bir şekilde ileri kardiyak
yaşam desteği başlandı ve yönetildi, hastaların ileri havayolu endotrakeal entübasyon ile sağlandı. Hastalar randomize edilerek
iki gruba ayrıldı. Her gruba 15’er hasta dahil edildi. Resüsitasyon ekibi tarafından bir gruba balon-valf ile manuel; diğer gruba
da mekanik ventilatör ile ‘KPR modu’nda ventilasyon yapıldı. Müdahale boyunca 0-5-10-15-20. dakikalardaki laktat düzeyleri,
spontan dolaşımın geri dönüşü sağlanması, sağlandı ise süresi kaydedildi ve gruplar arasında karşılaştırıldı.
Bulgular: Hastaların yaş ortalaması 47.8 ve 16sı erkek 14ü kadın cinsiyette idi. Minimum 20 dk kardio pulmoner resüsitasyon
uygulandı. 4 hastada rosc sağlandı. Laktat düzeyleri mekanik ventilatör grubunda 0-20. dakika arasında azalırken balon-valf
ile manuel ventilasyon grubunda artış eğiliminde izlendi. Ventilasyon yönteminin spontan dolaşımın geri dönüşü üzerine etkisi
açısından gruplar arasında anlamlı bir fark bulunmadı (p>0.05).
Sonuç: Mekanik ventilatör kullanımının, manuel bag-valve ventilasyon yerine spontan dolaşımın geri dönüşünü olumsuz
etkilemediği gözlemlendi. Ayrıca, mekanik ventilasyon grubunda, bag-valve manuel ventilasyon grubuna kıyasla laktat seviyelerinin düşme eğiliminde olduğu not edilmiştir.

Keywords

İleri havayolu, ventilasyon, KPR sırasında mekanik ventilasyon, balon-valf ventilasyon

Ethical Statement

Çalışmamı karar no:2019/21 ve tarih:14.11.2019 etik kurul onayı ile yürüttüğümü beyan ederim.

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