Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality, with low survival probabilities to hospital discharge. Despite the frequent use of airway management and mechanical ventilation during resuscitation, there is limited evidence regarding the optimal ventilation strategy to improve oxygen delivery and patient outcomes. The present study aims to investigate the effects of positive-end-expiratory-pressure (PEEP) set at 5 mbar compared to zero-end-expiratory-pressure (ZEEP) on the return of spontaneous-circulation (ROSC) in adult patients with OHCA.
This is a prospective, multicenter, cluster-randomized controlled trial conducted across emergency medical services (EMS) in the regions of Guetersloh, Minden-Luebbecke and Osnabrueck. Adult patients (\>= 18 years) with OHCA who are undergoing mechanical ventilation through an airway device will be enrolled. The clusters (regional district) will be randomized into two groups: one group will receive ventilation with PEEP set at 5 mbar (intervention group), while the other group will receive ventilation with ZEEP (control group). The study's primary endpoint is the rate of ROSC. Secondary endpoints include rate of re-arrest, death during pre-hospital care phase, hospital admission during ongoing resuscitation, hospital admission with spontaneous circulation, peripheral oxygen saturation and end tidal CO2 at hospital admission.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
600
Positiv-End-Expiratory Pressure
Zero-End-Expiratory Pressure
Emergency Medical Services
Gütersloh, North Rhine-Westphalia, Germany
RECRUITINGJWK Minden
Minden, North Rhine-Westphalia, Germany
RECRUITINGEmergency Medical Services
Osnabrück, Germany
RECRUITINGThe return of spontaneous circulation (ROSC)
The primary outcome is the ROSC, defined according to the Utstein template by the presence of a palpable pulse during or after resuscitation. This will be measured as a binary outcome (palpable pulse, yes or no).
Time frame: During or after resuscitation
Re-Arrest-Rate
Any need for chest compressions after ROSC (yes vs. no)
Time frame: Upon hospital admission
Death during pre-hospital care phase
Any death during pre-hospital care phase (yes vs. no)
Time frame: Upon hospital admission
Hospital admission during ongoing resuscitation
Need for chest-compressions at hospital admission (yes vs. no)
Time frame: at hospital admission
Hospital admission with spontaneous circulation
Hospital admission with spontaneous circulation without need for chest compressions (yes vs. no)
Time frame: at hospital admission
SpO2 at hospital admission
SpO2 at hospital admission (%)
Time frame: at hospital admission
FiO2 at hospital admission
FiO2 at hospital admission (%)
Time frame: at hospital admission
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