Aim The effect of positive end-expiratory pressure (PEEP) during intermittent positive pressure ventilation in patients undergoing cardiopulmonary resuscitation (CPR) on outcome is unknown. The aim of this study was to evaluate the association between the use of PEEP during cardiopulmonary resuscitation and clinical outcomes in out-of-hospital cardiac arrest (OHCA) patients. Methods We conducted a single-centre observational cohort study using a retrospective analysis of data collected prospectively within a dedicated research registry of adult OHCA patients managed by a physician-staffed prehospital emergency medical team. All included patients were intubated and ventilated either with mechanical ventilation using PEEP or with manual ventilation without PEEP. Intratracheal pressure was continuously recorded via a catheter connected to a portable device, allowing objective verification of PEEP application and ventilation rate. The association between mechanical ventilation with PEEP use and clinical outcomes was evaluated using multivariable logistic regression adjusted for relevant confounders. Results 362 patients were included, with a median age of 65 years (54–79), of whom 250 (69.1%) were male. Median ventilation rate was 15 breaths/min (10–19). Of all patients, 149 (41.2%) achieved Return Of Spontaneous Circulation (ROSC) and 31 (8.6%) survived to hospital discharge. The adjusted odds ratio (OR) of mechanical ventilation with PEEP for achieving ROSC was 1.58 (95% CI 1.01–2.50, p = 0.048). The unadjusted OR of mechanical ventilation with PEEP for survival to hospital discharge was 2.22 (95% CI 1.03–4.78; p = 0.037). Conclusion The use of mechanical ventilation with PEEP during CPR in OHCA patients was associated with higher likelihood of ROSC.
