Spotlight on Research

Hyperventilation of a patient in cardiac arrest has been shown to impact negatively on survival but maintenance of optimal ventilation is not as easy as it may sound. Previous research suggests that rescuers deliver ventilations outside of recommendations during out-of-hospital cardiac arrest (OHCA).

This study investigated whether compliance with ventilation recommendations by ambulance clinicians could be improved using the Zoll Accuvent real-time ventilation feedback device (VFD). In total, 106 participants (paramedic and non-paramedic) undertook simulated advanced life support (ALS) using a manikin on a stationary ambulance. A supraglottic device with catheter mount and ventilation bag were already in situ and defibrillation and cardiopulmonary resuscitation (CPR) feedback pads were applied. Each pair of participants completed ALS scenarios providing asynchronous chest compressions and ventilations over two 2-minute periods. In the first scenario, participants received compression quality feedback but no ventilation feedback; in the second scenario, real-time ventilation feedback was provided.

Primary outcome was % difference in ventilation compliance with and without feedback. Secondary outcomes were differences between paramedic and non-paramedic clinicians and compliance with chest compression guidelines. The median ventilation rate without feedback was 10 (IQR 8–14, range 4–30) compared with 9 (IQR 9–9, range 6–17) with feedback; median tidal volume without feedback was 630 ml (IQR 518–725, range 201–1114) compared with 546 ml (IQR 531–560, range 490–750) with feedback. The proportion of clinicians ~50% compliant with European Resuscitation Council ventilation recommendations were significantly greater with ventilation feedback compared to without (91% vs. 9%). Paramedics out performed non-paramedic clinicians with and without feedback.