Abstract 280: Effectiveness of Bag-Valve-Mask Ventilation During Out-of-Hospital Pediatric CPR

Abstract

Background: Few studies have measured ventilation during early cardiopulmonary resuscitation (CPR) before advanced airway placement. Resuscitation guidelines recommend pauses after every 15 or 30 chest compressions to deliver ventilations for children. The effectiveness of bag-valve-mask (BVM) ventilation delivered during the pause in chest compressions is unknown. Hypothesis: Lung inflation occurs infrequently with BVM ventilation during 30:2 (and 15:2) CPR. Aim: To determine the incidence of lung inflation with BVM ventilation during 15:2 or 30:2 CPR for pediatric OHCA. Methods: This is a retrospective, observational study of 63 OHCA patients, <18 years of age, with non-traumatic cardiac arrest from the Dallas-Fort Worth Center for Resuscitation Research registry. Emergency medical service rescuers provided 30:2 or 15:2 CPR with BVM ventilation and ≥ 2 min of recorded CPR. We measured bioimpedance ventilation (lung inflation) waveforms in the pauses between chest compression segments recorded through defibrillation pads. A detectable ventilation waveform had a bioimpedance amplitude ≥0.5 Ohm and duration ≥1 sec. We measured the incidence of ventilation in two pre-specified groups: patients with ventilation waveforms in <50% of pauses (Group 1) vs. those with waveforms in ≥50% of pauses (Group 2). Results: The mean duration of 30:2 or 15:2 CPR was 15(8) min prior to advanced airway placement. During this period, we identified 683 pauses in chest compressions, 386 measurable ventilations, and the median (IQR) number of ventilations was 2 (0-4). Of 20 advanced airway attempts, nine were successful.Group 1 (N=48) had a median 8 pauses and 1.5 ventilations/patient, Group 2 (N= 15) had a median 10 pauses and 12 ventilations/patient (Table). Return of spontaneous circulation for Group 1 (15%, 7/48) vs. Group 2 (33%, 5/15). Conclusion: This study shows that use of a BVM device results in infrequent lung inflation during 30:2 or 15:2 CPR in pediatric patients.