Understanding Mechanical Ventilation in Emergency Care

Ventilation is vital in emergency care, particularly in critical situations where it can sustain respiratory function and ensure adequate oxygen delivery when a patient is unable to breathe independently.

There are two primary types of ventilation used in clinical settings: manual and mechanical. While both serve to support or replace spontaneous breathing, mechanical ventilation offers several critical advantages over manual methods—such as consistent airflow, precise control of oxygen delivery, and reduced provider fatigue—which can be life-saving in emergency or prolonged care situations.¹

NAEMSP (National Association of EMS Physicians) recommends the use of invasive mechanical ventilation for hypoxic respiratory failure, hypercapnic respiratory failure, and airway protection in their position statement. These may be on initial contact from an emergency ground ambulance response, or during interfacility transfers via critical care teams. ³

WEINMANN supports the use of mechanical ventilation in emergency medicine; and with our simple, easy-to-use mechanical ventilators, first responders can make a life-saving difference in those emergency situations.

Definition: What is mechanical ventilation?

Mechanical ventilation is a method used to regulate and support alveolar ventilation when spontaneous breathing is largely or entirely insufficient. With the support of a mechanical ventilation system, both a constant volume and a constant respiratory rate are guaranteed. Positive airway pressure ensures that the respiratory gas is transported into the lung.

Spontaneous breathing is an autonomous, physiological process. In a healthy person, spontaneous breathing takes place continuously and without conscious control, especially during sleep. However, under certain pathophysiological conditions, such as serious trauma or illness, this capacity may be impaired or lost completely. 

As a result, there are various ventilation methods, including mechanical ventilation, that may be required in different situations to support respiratory function.

For manual ventilation, on the other hand, a bag-valve mask (BVM) or tube can be used to restore airflow to the lungs.

Types/Modes of Mechanical Ventilation

The purpose of mechanical ventilation is to support or completely take over a person’s breathing when they are unable to do so on their own. It ensures that the body continues to receive sufficient oxygen and eliminate carbon dioxide, helping stabilize patients in critical condition.

There are many different modes of mechanical ventilation and 2 primary types: invasive and non-invasive.

Invasive Mechanical Ventilation

Invasive mechanical ventilation is a life-support technique where a tube is inserted into the patient’s airway (usually via the mouth or nose into the trachea) to deliver controlled breaths using a ventilator. It supports or replaces spontaneous breathing in critically ill or anesthetized patients. The machine pushes air (often with added oxygen) into the lungs and allows passive exhalation.

Non-invasive Mechanical Ventilation

Non-invasive mechanical ventilation (NIV) delivers air into the lungs using a tight-fitting mask rather than a tube inserted into the airway. It helps patients breathe more effectively while avoiding the risks associated with intubation. Common forms include CPAP (Continuous Positive Airway Pressure) and BIPAP (Bilevel Positive Airway Pressure), often used for conditions like respiratory distress.

Mechanical Ventilation vs. Intubation

Mechanical ventilation and intubation are related in purpose, but distinct in procedure. Intubation is a manual procedure involving the insertion of a breathing tube into the trachea to secure it, a practice commonly performed in emergency or critical care settings. 

Mechanical ventilation refers to the use of a machine to assist or fully control a patient’s breathing by cycling air into and out of the lungs, often through an intubation tube. While intubation provides direct access to the airway, mechanical ventilation is the therapy that follows when a patient can’t breathe adequately on their own.

Why is manual ventilation difficult?

Manual ventilation is most commonly performed using a BVM, a technique favored for its simplicity. This method involves attaching a mask to a ventilation bag, which is connected to an oxygen source.

The mask is placed over the patient’s nose and mouth, while the provider manually compresses the bag. This action delivers oxygen through the patient’s airways, with a one-way valve preventing exhaled air from re-entering the bag.

Clear airways, an adequately sealed mask, and the correct technique are essential for this procedure. Bag-valve-mask ventilation generally also requires 2 first responders. 

In actual fact, this method is NOT easy to implement, and studies have shown that even experienced EMS providers have difficulties with it.⁵

Most importantly, it lacks a reliable method for measuring the ventilation volume or pressure exerted on the airway. The delivery of oxygen into the lungs by means of manual ventilation can only be controlled to a limited extent. Without real-time feedback, there is a high risk of dangerous pressure peaks that could cause damage to the lungs.

Another possible risk associated with bag-valve-mask ventilation is an excessive rate of breaths per minute.⁶ This is known as hyperventilation and can potentially lead to negative side effects on the patient’s circulatory condition.

Using Mechanical Ventilation in Emergency Medicine

Mechanical ventilation is used in various areas of emergency medicine. For example, if a patient has been anesthetized at the scene of the emergency and can no longer breathe on their own, mechanical ventilation will be required. 

In emergency situations such as cardiac arrest, it is essential to resuscitate the patient as quickly as possible and ensure an adequate supply of oxygen. 

Mechanical ventilation can save lives during resuscitation by maintaining consistent gas exchange in the lungs until the patient can breathe independently again. Below are a few examples of indications for mechanical ventilation: 

• Respiratory failure (hypoxemia or hypercapnia)
• Inadequate or absent respiratory effort
• Airway protection (e.g. altered mental status)
• Cardiopulmonary arrest
• Severe shock or multi-organ failure
• Neuromuscular disorders affecting breathing
• Severe trauma (e.g. chest injury, head injury)
• Sepsis with respiratory compromise

Mechanical ventilation is also important for transportation in an ambulance or during patient transfer. It ensures a constant and consistent oxygen supply during transportation, without requiring EMS providers to manually administer ventilation for an extended period of time. Furthermore, mechanical ventilation also contributes to user safety.

Complications of Mechanical Ventilation

Mechanical ventilation is proven to be a life-saving intervention, but nevertheless, it comes with potential risks. Common complications include ventilator-associated pneumonia (VAP), lung injury from high pressure (barotrauma) or overdistension (volutrauma), and oxygen toxicity. Prolonged use could also lead to respiratory muscle weakness or airway injuries.

Advantages of a Mechanical Ventilation System

Mechanical ventilation offers many advantages over bag-valve-mask ventilation, with studies showing that mechanical ventilation is more effective than its manual counterpart.⁷

In one study from the Emergency Medical Service of Madrid, Spain, the use of a bag-valve-mask during resuscitation led to massive hypoventilation, whereas the ventilator device was able to ensure more effective ventilation.⁸

These results are supported by a retrospective study from the US. It showed that more patients with mechanical ventilation survived until hospital discharge and had etCO₂ values within recommended values at the end of EMS care.⁹

Ventilators are also advantageous when it comes to crew resource management (CRM). For example, effective bag-valve-mask ventilation typically requires two EMS providers. Ideally, one person should attach the mask to the patient’s face and hold it in place, while the other person carries out the actual ventilation.

Consequently, this practice ties up two EMS providers to one task, thus preventing them from doing anything else.

Therefore, one of the primary advantages of ventilators is to free up more time for EMS providers to perform other tasks and document the emergency, while guaranteeing more effective ventilation.¹⁰This reduces the manual work required and allows medical staff to concentrate on the cause of the emergency. 

At first glance, the equipment for bag-valve-mask ventilation appears more compact and lightweight. However, ventilators can also be lightweight and portable. In addition, they are easy to operate, and their functionality is less dependent on the precise technique of the EMS provider, as is often the case with bag-valve-mask ventilation.

In their position statement, NAEMSP summarizes the benefits from mechanical ventilation as follows: 

1. Provide the intubated patient with consistency in ventilation parameters including respiratory rate and tidal volume.
2. Maximizing ventilation, improving oxygenation, and the elimination of carbon dioxide.
3. Limiting airway pressures and potential complications including barotrauma, gastric distention, and hypotension.
4. Allow the transport team to focus on other aspects of patient care.¹¹

MEDUMAT Easy CPR emergency ventilator

MEDUMAT Easy CPR emergency and transport ventilator is specially designed for use in emergency situations and suitable for both outdoors and in transport. It offers the option of invasive ventilation, and, using a special CPR mode, can also facilitate cardiopulmonary resuscitation in accordance with medical guidelines. 

The MEDUtrigger allows manual ventilation directly at the patient’s mask by pressing just a single button. The intuitive operation of MEDUMAT Easy CPR and its compact size make it an ideal option for transportation.

¹ Idris Ahamed H. (2023) Bag-Valve-Mask Ventilation and Survival from Out-of-Hospital Cardiac Arrest: A Multicenter Study.

² The Menegazzi Scientific Sessions: Research Abstracts for the 2025 National Association of EMS Physicians Annual Meeting, Prehospital Emergency Care, 29:sup1, S1-S113, DOI: 10.1080/10903127.2024.2425372

³ Amado Alejandro Baez, Zaffer Qasim, Susan Wilcox, William B. Weir, Patrick Loeffler, Bradley Michael Golden, Daniel Schwartz & Michael Levy (2022) Prehospital Mechanical Ventilation: An NAEMSP Position Statement and Resource Document, Prehospital Emergency Care, 26:sup1, 88-95, DOI: 10.1080/10903127.2021.1994676

⁴ Neth M et al (2020): Ventilation in Simulated Out-of-Hospital Cardiac Arrest Resuscitation Rarely Meets Guidelines

⁵ Neth M et al (2020): Ventilation in Simulated Out-of-Hospital Cardiac Arrest Resuscitation Rarely Meets Guidelines

⁶ Aufderheide TP, Sigurdsson G, Pirrallo, RG, Yannopoulos D, McKnite S, Von Briesen C, Sparks CW, Conrad CJ, Provo TA, Lurie KG. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109(16):1960-1965.

⁷ Hernández-Tejedor A. (2023): Ventilatory improvement with mechanical ventilator versus bag in non-traumatic out-of-hospital cardiac arrest: SYMEVECA study, phase 1; Chauhan A. et al (2023): Comparison of hemodynamic consequences of hand ventilation versus machine ventilation for transportation of post-operative pediatric cardiac patients

⁸ Hernández-Tejedor A, González Puebla V, Corral Torres E, Benito Sánchez A, Pinilla López R, Galán Calategui MD. Ventilatory improvement with mechanical ventilator versus bag in non-traumatic out-of-hospital cardiac arrest: SYMEVECA study, phase 1. Resuscitation. 2023 Nov;192:109965. doi: 10.1016/j.resuscitation.2023.109965. Epub 2023 Sep 12. PMID: 37709164.

⁹ The Menegazzi Scientific Sessions: Research Abstracts for the 2025 National Association of EMS Physicians Annual Meeting, Prehospital Emergency Care, 29:sup1, S1-S113, DOI: 10.1080/10903127.2024.2425372

¹⁰ Automatic transport ventilator versus bag valve in the EMS setting: a prospective, randomized trial

¹¹ Amado Alejandro Baez, Zaffer Qasim, Susan Wilcox, William B. Weir, Patrick Loeffler, Bradley Michael Golden, Daniel Schwartz & Michael Levy (2022) Prehospital Mechanical Ventilation: An NAEMSP Position Statement and Resource Document, Prehospital Emergency Care, 26:sup1, 88-95, DOI: 10.1080/10903127.2021.1994676