Abstract Body: Introduction: Ventilations are a critical component of CPR, however, the optimal ventilation strategy during cardiac resuscitation is not known. Recent evidence has suggested that regardless of the optimal strategy, delivery of ventilations are often not compliant with guideline recommendations. Simulation studies have found that the use of real-time feedback significantly improves ventilation quality. However, the use of real-time feedback has not been studied in clinical practice.
Objective: To determine whether the use of real-time feedback improved compliance with guideline recommendations for ventilation rate and volume during out-of-hospital cardiac resuscitation.
Methods: This was a before-and-after study with six paramedic services in Ontario, Canada. We enrolled adult, OHCA patients where the ZOLL Accuvent® device was used to measure ventilation rate and volume. In the before phase, the Accuvent® was used to measure ventilations, however, providers were blinded to the real-time feedback. In the after phase, the feedback dashboard was activated, and providers used the real-time feedback to guide ventilations. The primary outcome was the proportion of guideline compliant ventilations (rate and volume) in the before and after time periods. We also examined for associations between ventilations and return of circulation (ROSC). Compliance in the before and after periods was compared using student T test with P value <0.05 representing a significant result. The association between ventilations and ROSC was examined using multivariable logistic regression.
Results: We enrolled 412 patients in the study (191 in the before phase and 221 in the after phase). We found significant improvements in the after phase (with feedback) compared to the before phase (without feedback) in both ventilation rate (52% compliant vs 29% compliant, P value<0.001) and ventilation volume (28% vs 21%, P value <0.001). These results were consistent with or without advanced airways, and intra-arrest and post-cardiac arrest. There was no association between ventilation rate or volume and ROSC.
Conclusion: Overall, compliance with guideline recommendations for ventilation during cardiac arrest was low. The use of real-time feedback improved the proportion of guideline-compliant ventilations during cardiac resuscitation. Further work is required to improve the use of real-time ventilation feedback, and to determine the impact of ventilations on patient outcomes.