Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study.

Area of Science:

• Emergency Medicine
• Cardiology
• Critical Care Medicine

Background:

• Few studies have quantified ventilation during early cardiopulmonary resuscitation (CPR) before advanced airway placement.
• The effectiveness of bag-valve-mask ventilation during chest compression pauses is not well understood.
• Resuscitation guidelines recommend ventilations during pauses in chest compressions, but incidence and outcomes are unclear.

Purpose of the Study:

• To determine the incidence of lung inflation using bag-valve-mask ventilation during 30:2 CPR.
• To investigate the association between ventilation effectiveness and outcomes in out-of-hospital cardiac arrest (OHCA).

Main Methods:

• Analysis of 1976 OHCA patients from the Resuscitation Outcomes Consortium CCC study (30:2 CPR arm).
• Utilized thoracic bioimpedance to detect ventilation waveforms (≥0.5 Ω, ≥1 s duration) during chest compression pauses (3-15 s).
• Compared outcomes between patients with ventilation in <50% of pauses (group 1) and ≥50% of pauses (group 2).

Main Results:

• Lung inflation occurred infrequently; 60% of patients had ventilation in <50% of pauses.
• Patients with ventilation in ≥50% of pauses (group 2) showed significantly higher rates of return of spontaneous circulation (40.7% vs 25.2%).
• Group 2 also had improved survival to hospital discharge (13.5% vs 4.1%) and survival with favorable neurological outcome (10.6% vs 2.4%) compared to group 1.

Conclusions:

• Bag-valve-mask ventilation infrequently resulted in lung inflation during 30:2 CPR.
• Achieving lung inflation in ≥50% of pauses during CPR was associated with better patient outcomes, including survival and neurological recovery.