Ventilation Monitoring in Out-of-Hospital Cardiac Arrest Care.
Resuscitation · 2026-10-29 · Quasi-experimental
Abstract
INTRODUCTION: Adherence to American Heart Association (AHA) ventilation guidelines during cardiac arrest is challenging. METHODS: Prospective, Before/After quality assurance study determining adherence to AHA ventilation guidelines in adults with out-of-hospital cardiac arrest treated by Milwaukee County Emergency Medical Services and Kenosha Fire in Wisconsin using (Before) end tidal carbon dioxide [ETCO2] to monitor ventilations - Real BVM Help® applied but blinded versus (After) Real BVM Help®. PRIMARY ENDPOINTS: mean per-person proportion (%) of ventilations in-target for rate, tidal volume, and both rate and tidal volume. AHA 2020 guidelines were followed. RESULTS: From 9/29/22-12/22/23, 278 patients were entered (148 Before/130 After). Average age: 62.3±16.7 years; 185 (67%) male. Mean per-person proportion (%) of ventilations in Before/After Groups in-target for rate (47.7±25.1% vs 74.4±24.1% respectively, p<0.0001), tidal volume (15.3±15.4% vs 45.4±23.8% respectively, p<0.0001), and rate and tidal volume (7.5±9.6% vs 39.0±23.3% respectively, p<0.0001) were significantly higher in the After Group. In the Before Group, using ETCO2 to monitor all ventilations (N=22,037 ventilations), only 43.8% were in-target for rate, 13.5% in-target for tidal volume, and 6.8% in-target for rate and tidal volume with a lower-than-target tidal volume delivered in 58.2% of all ventilations. CONCLUSION: Real BVM Help® was associated with statistically significant and clinically meaningful improvement in adherence to AHA ventilation guidelines. ETCO2 monitoring failed to approach both rate and tidal volume guideline adherence with a lower-than-target tidal volume being the most common parameter delivered out-of-target (58.2%). Ventilation rate and tidal volume monitoring with real-time feedback should be considered during treatment of cardiac arrest.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Bag-valve-mask ventilation · Capnography · CPR feedback devices
Related articles
- Real-time feedback during bag-valve-mask ventilation for out-of-hospital cardiac arrest: a before-and-after study (VEntilation during Cardiac Arrest Resuscitation Study, VECARS-2). (Resuscitation, 2026)
- Manual bag-valve-mask ventilation during out-of-hospital cardiopulmonary resuscitation: a prospective observational study. (Resuscitation, 2025)
- Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. (Resuscitation, 2023)
- Predefibrillation end-tidal CO2 and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study. (Emerg Med J, 2023)
- [I-Gel® laryngeal mask versus bag-valve-mask in instrumental cardiopulmonary resuscitation under capnographic monitoring: Cluster-randomized pilot clinical trial]. (Aten Primaria, 2021)
- Manual ventilation quality is improved with a real-time visual feedback system during simulated resuscitation. (Int J Emerg Med, 2020)