Real-time feedback tied to improved compliance with pre-defined ventilation targets during CPR, reveals study

Ventilations play a vital role in cardiopulmonary resuscitation (CPR). However, there is inconsistent evidence regarding the best approach to ventilation in managing cardiac arrest. Recent findings indicate that, irrespective of the ideal ventilation technique, actual ventilations frequently do not adhere to guideline recommendations. Recent study examined the impact of real-time feedback on ventilation quality during out-of-hospital cardiac arrest resuscitation. It was a before-and-after study conducted across four paramedic services in Ontario, Canada. The study enrolled 412 adult out-of-hospital cardiac arrest patients, with 191 in the before phase (without feedback) and 221 in the after phase (with feedback). The study used the ZOLL AccuventÒ device to measure ventilation rate and volume during resuscitation. In the before phase, the AccuventÒ was used but 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 their ventilations. All other aspects of resuscitation remained consistent.

Objectives and Analysis

The main objective was to compare the proportion of each case that was compliant with pre-defined ventilation targets (rate of 10 ± 2 breaths/min, volume of 450 ± 50 mL) with and without real-time feedback. The study also examined the impact of advanced airway use on ventilation quality and the association between ventilation parameters and return of spontaneous circulation (ROSC).

Key Results

The results showed significant improvements in both ventilation rate and volume compliance in the after phase (with real-time feedback) compared to the before phase (without real-time feedback). The proportion of ventilations compliant with targets for rate increased from 29% to 52%, and for volume increased from 21% to 28%. The proportion compliant with both rate and volume targets increased from 7% to 18%.

Ventilation Compliance Findings

The study did not find any differences in ventilation compliance with or without advanced airways, or during intra-arrest or post-cardiac arrest periods. The exploratory analysis also did not find any association between ventilation parameters and ROSC.

Conclusion

In conclusion, the use of real-time feedback was associated with improved compliance with pre-defined ventilation targets during cardiac arrest resuscitation. However, further work is required to optimize the use of real-time ventilation feedback and determine its impact on patient outcomes.

Key Points

1. The study examined the impact of real-time feedback on ventilation quality during out-of-hospital cardiac arrest resuscitation. It was a before-and-after study conducted across four paramedic services in Ontario, Canada, with 412 adult out-of-hospital cardiac arrest patients enrolled.

2. The study used the ZOLL AccuventÒ device to measure ventilation rate and volume during resuscitation. In the before phase, the AccuventÒ was used but providers were blinded to the real-time feedback, while in the after phase, the feedback dashboard was activated and providers used the real-time feedback to guide their ventilations.

3. The main objective was to compare the proportion of each case that was compliant with pre-defined ventilation targets (rate of 10 ± 2 breaths/min, volume of 450 ± 50 mL) with and without real-time feedback. The study also examined the impact of advanced airway use on ventilation quality and the association between ventilation parameters and return of spontaneous circulation (ROSC).

4. The results showed significant improvements in both ventilation rate and volume compliance in the after phase (with real-time feedback) compared to the before phase (without real-time feedback). The proportion of ventilations compliant with targets for rate increased from 29% to 52%, and for volume increased from 21% to 28%. The proportion compliant with both rate and volume targets increased from 7% to 18%.

5. The study did not find any differences in ventilation compliance with or without advanced airways, or during intra-arrest or post-cardiac arrest periods. The exploratory analysis also did not find any association between ventilation parameters and ROSC.

6. In conclusion, the use of real-time feedback was associated with improved compliance with pre-defined ventilation targets during cardiac arrest resuscitation. However, further work is required to optimize the use of real-time ventilation feedback and determine its impact on patient outcomes.

Reference –

I. Drennan et al. (2024). The Impact Of Real-Time Feedback On Ventilation Quality During Out-Of-Hospital Cardiac Arrest: A Before-And-After Study.. *Resuscitation*, 110381 . https://doi.org/10.1016/j.resuscitation.2024.110381.