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Written by Michael Stocker
For the majority of out-of-hospital cardiac arrest (OHCA) patients undergoing 30:2 compressions to breaths CPR prior to definitive airway placement, bag-valve mask (BVM) ventilations did not achieve adequate lung volumes most of the time. Receiving adequate BVM ventilations >50% of the time was associated with significantly higher rates of return of spontaneous circulation (ROSC) and survival.
40% of the time, it works every time
This secondary analysis of the Resuscitation Outcomes Consortium (ROC) Trial of Continuous Compressions versus Standard CPR in Patients with Out-of-Hospital Cardiac Arrest (CCC trial) examined the quality of BVM ventilations using defibrillator bioimpedance data as a surrogate measure of ventilation volume. A total of 1,976 of the 15,250 patients in the ROC CCC trial were included after excluding those receiving continuous compressions, defibrillators recording insufficient bioimpedance data, and recorded CPR < 2 minutes. Ventilations equating to >250 mL were considered adequate. Patient were split into two groups defined by whether they received adequate ventilations during greater or less than 50% of pauses in compressions. 60% (n=1,177) of patients received adequate ventilations less than 50% of the time. The group receiving >50% adequate ventilations had markedly better outcomes across the board, to include prehospital and any time ROSC, survival to hospital discharge, and survival with favorable neurologic outcome.
How will this change my practice?
This reiterates just how crucial it is to hone your bagging technique to perfection. Keeping an effective BVM seal and delivering adequate breaths can be difficult enough during CPR in a stationary resuscitation bay, so it isn’t hard to imagine this difficulty increasing in the back of an ambulance. Prehospital study or not – I will pay closer attention to effective BVM technique during codes in my shop, and I encourage EMS directors to reiterate this critical skill in upcoming training.
Editor’s note: Also read the other spoonfuls below. Considered all together, they made me appreciate how much we likely have to gain in OHCA if our best airway method isn’t even providing adequate ventilation half the time. ~Nick Zelt
Source
Bag-Valve-Mask Ventilation and Survival from Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023 Nov 12. doi: 10.1161/CIRCULATIONAHA.123.065561. Epub ahead of print.
