Volume-controlled mechanical ventilation shows no difference in ROSC compared to manual ventilation in cardiac arrestTrial results show no difference between mechanical and manual ventilation

Resuscitation Published September 2, 2026 Study authors: Wittig Johannes, Sommer Anna, Bürgstein Emma, Krogh Kristian, Løfgren Bo, Sutton Robert M, Orlob Sim… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Note that volume-controlled mechanical ventilation shows no significant difference in ROSC compared to manual ventilation.

This meta-analysis evaluated the efficacy of volume-controlled mechanical ventilation compared to manual ventilation, pressure-controlled ventilation, and CPR-specific modes in patients and children with cardiac arrest and an advanced airway. The analysis included 13 articles, comprising 6 randomized trials (n=461) and 7 non-randomized studies (n=4607).

The primary finding was no difference in return of spontaneous circulation (ROSC) between volume-controlled mechanical ventilation and manual ventilation (odds ratio, 1.31; 95% confidence interval, 0.64-2.71) based on 120 patients from two randomized trials. Results regarding comparisons to pressure-controlled and CPR-specific modes were reported as uncertain.

Several limitations were noted, including the absence of reported data for children and the fact that comparisons to pressure-controlled and CPR-specific modes were limited to a single trial each. Furthermore, the non-randomized studies were at serious or critical risk of bias. The authors state the certainty of evidence is very low to low. Consequently, the clinical relevance of these findings is limited by the low certainty of evidence and the high risk of bias in the non-randomized component of the analysis.

How this fits prior evidence

This meta-analysis addresses a gap in the management of advanced airways in cardiac arrest by comparing ventilation modes. It provides evidence that volume-controlled mechanical ventilation does not differ from manual ventilation in terms of ROSC. This finding complements existing evidence that mechanical CPR does not show statistically significant differences from manual CPR regarding chest injuries, and that triple therapy of vasopressin, steroids, and epinephrine improves ROSC in in-hospital cardiac arrest.

When someone's heart stops, every second counts. Doctors must decide quickly how to deliver oxygen to the body. One common method is using a machine to provide volume-controlled mechanical ventilation, while another is manual ventilation. This means a person breathes into a bag or mask by hand.

Researchers looked at data from 13 different articles involving over 4,600 patients. They specifically looked at people who already had an advanced airway in place. The results showed no significant difference in the number of patients who regained a heartbeat when comparing machine-assisted volume-controlled ventilation to manual ventilation.

It is important to note that the evidence for these findings is currently very low to low certainty. Many of the studies used were not randomized, and there were no reports on how these methods worked for children. Because the data is limited, doctors should still use their best judgment based on the specific needs of the patient.

What this means for you:

Current evidence shows no significant difference in survival rates between manual and volume-controlled mechanical ventilation.

Common questions

Does a machine help more than manual breathing for heart attacks?

The study found no significant difference in the number of patients who regained a heartbeat when comparing volume-controlled mechanical ventilation to manual ventilation. Because the evidence is of low to low certainty, it is hard to say if one method is better than the other for a specific patient.

Is it safe to use mechanical ventilation for cardiac arrest?

The study did not report any specific safety data, adverse events, or problems with tolerability for either manual or mechanical ventilation. You should speak with a medical professional regarding specific safety protocols for emergency care.

Does this research apply to children?

No, the study did not include any data specifically regarding children. The findings were based on a population of adults and children, but the specific data for children was not reported in the results.

Study Details

Study typeMeta analysis

Sample sizen = 461

EvidenceLevel 1

PublishedSep 2026

PMID42398849

View Original Abstract ↓

OBJECTIVE: To assess the evidence on volume-controlled mechanical ventilation versus manual ventilation or other ventilation modes during cardiopulmonary resuscitation (CPR). METHODS: On 18 March 2026, we searched PubMed, Embase, and Web of Science (PROSPERO: CRD420251110999). Randomized trials and non-randomized studies in children or adults with cardiac arrest and an advanced airway were included. Risk of bias was assessed using RoB2 and ROBINS-I tools. Meta-analyses were performed when appropriate, and certainty of evidence was assessed using GRADE. RESULTS: We screened 12,004 abstracts and included 13 articles consisting of six trials enrolling 461 patients and seven non-randomized studies including 4607 patients. No study reported data on children. Meta-analysis of 120 patients from two randomized trials comparing volume-controlled to manual ventilation showed no difference for return of spontaneous circulation (ROSC) (odds ratio, 1.31; 95%-confidence interval, 0.64-2.71). Comparisons to pressure-controlled and CPR-specific modes were limited to a single trial each, with uncertain results. Randomized trials were at low to high risk of bias. Non-randomized studies were at serious or critical risk of bias. The certainty of evidence was very low to low across comparisons. CONCLUSION: Very low to low certainty evidence from randomized trials suggests no significant difference in clinical outcomes between volume-controlled mechanical ventilation and manual ventilation. The relative effectiveness of volume-controlled ventilation compared to other mechanical ventilation modes is uncertain.

Volume-controlled mechanical ventilation shows no difference in ROSC compared to manual ventilation in cardiac arrestTrial results show no difference between mechanical and manual ventilation

How this fits prior evidence

Common questions

Study Details

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Volume-controlled mechanical ventilation shows no difference in ROSC compared to manual ventilation in cardiac arrestTrial results show no difference between mechanical and manual ventilation

How this fits prior evidence

Common questions

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Study Details

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