Written by Michael Stocker
Spoon Feed
Bag valve mask (BVM) ventilations provided by Basic Life Support (BLS) teams during 30:2 cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) frequently fell well short of the guideline goals for expiratory tidal volume (Vte).
Taking the guesswork out of breathwork
How good are BVM ventilations from prehospital providers in OHCA? How do we even measure that? While previous studies have used indirect surrogates, this prospective observational study utilized a ventilation monitoring device attached between the bag and mask to assess the quality of BVM ventilations provided by BLS providers to 106 adult OHCA patients during 30:2 CPR. The primary outcome was Vte, with secondary outcomes such as inspiratory tidal volume (Vti), rate, I/E ratio, and chest rise. Median Vte was 273 and 327 for the first and second ventilations respectively, falling well short of guideline goals of 500-600 mL. Median Vti was 525 and 531, indicating significant leak, possibly due to poor seal or stomach insufflation. Observed chest rise, BLS witnessed arrest, and I/E ratio <0.4 were associated with significantly higher Vte. Limitations include a small sample size, not deploying the device in all intended cases, and inability to track the sources of air leak; however, blinding the providers to the device’s display mitigated performance bias.
How will this change my practice?
While this highlights just how far we have yet to go in optimizing OHCA airway management, the most exciting takeaway here is the use of ventilation monitoring devices in prehospital medicine. Ventilation quality is vital to OHCA care, and real-time feedback tools could lead to drastic improvements. I am excited for more prehospital research with this class of devices and am cautiously optimistic they’ll become standard equipment on the streets in the not-so-distant future.
Source
Manual bag-valve-mask ventilation during out-of-hospital cardiopulmonary resuscitation: a prospective observational study. Resuscitation. 2025 Nov 12;217:110895. doi: 10.1016/j.resuscitation.2025.110895. Epub ahead of print. PMID: 41237844.
