Peri-Arrest Ventilation with Positive End-Expiratory-Pressure vs. Zero End-Expiratory-Pressure in Out-of-Hospital-Cardiac-Arrest (PerAVent) – a prospective, cluster-randomized multicenter trial

Peri-Arrest Ventilation with Positive End-Expiratory-Pressure vs. Zero End-Expiratory-Pressure in Out-of-Hospital-Cardiac-Arrest (PerAVent) – a prospective, cluster-randomized multicenter trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Peri-Arrest Ventilation with Positive End-Expiratory-Pressure vs. Zero End-Expiratory-Pressure in Out-of-Hospital-Cardiac-Arrest (PerAVent) – a prospective, cluster-randomized multicenter trial Mathini Vaseekaran, Tobias Vollmer, Christina Zeichen, Jochen Hinkelbein, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6140784/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jan, 2026 Read the published version in Trials → Version 1 posted 6 You are reading this latest preprint version Abstract Background: 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 5mbar compared to zero-end-expiratory-pressure (ZEEP) on the return of spontaneous-circulation (ROSC) in adult patients with OHCA. Methods: This is a prospective, multicenter, cluster-randomized controlled trial conducted across emergency medical services (EMS) in the regions of Gütersloh, Minden-Lübbecke, and Osnabrück. Adult patients (≥18 years) with OHCA who are undergoing mechanical ventilation through an airway device will be enrolled. The clusters (regional districts) 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 endtidal CO2 at hospital admission. Discussion: Optimal ventilation strategies during OHCA have not been well established. The use of PEEP may improve oxygenation and oxygen delivery. This study aims to provide crucial data on whether the application of PEEP at 5 mbar vs. 0 mbar can improve the probability of ROSC without adversely affecting hemodynamics. The findings could inform future guidelines on ventilation strategies in resuscitation. Trial registration: The trial is registered on ClinicalTrials.gov under the registration number NCT06836830. 24.02.2025 https://clinicaltrials.gov/study/NCT06836830?term=gerrit%20jansen&rank=2 Cardiac Arrest Positive End-Expiratory Pressure Ventilation Randomized Controlled Trial Emergency Medicine Resuscitation CPR Full Text Cite Share Download PDF Status: Published Journal Publication published 21 Jan, 2026 Read the published version in Trials → Version 1 posted Reviewers agreed at journal 19 Jul, 2025 Reviewers invited by journal 14 Jul, 2025 Editor invited by journal 05 Jun, 2025 Editor assigned by journal 05 May, 2025 First submitted to journal 04 May, 2025 Editorial decision: Minor revision 27 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6140784","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484907729,"identity":"d11fb22c-ba47-49aa-a53f-6ae2e0f1b5eb","order_by":0,"name":"Mathini 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