Abstract
ObjectivesTo investigate whether real-time ventilation feedback would improve provider adherence to ventilation guidelines. DesignNon-blinded randomised controlled simulation trial. SettingOne Emergency Medical Service trust in Copenhagen. Participants32 ambulance crews consisting of 64 on-duty basic or advanced life support paramedics from Copenhagen Emergency Medical Service. InterventionParticipant exposure to real-time ventilation feedback during simulated out-of-hospital cardiac arrest. Main outcome measuresThe primary outcome was ventilation quality, defined as ventilation guideline-adherence to ventilation rate (8–10 bpm) and tidal volume (500−600 ml) delivered simultaneously. ResultsThe intervention group performed ventilations in adherence with ventilation guideline recommendations for 75.3% (Interquartile range (IQR) 66.2%–82.9%) of delivered ventilations, compared to 22.1% (IQR 0%–44.0%) provided by the control group. When controlling for participant covariates, adherence to ventilation guidelines was 44.7% higher in participants receiving ventilation feedback. Analysed separately, the intervention group performed a ventilation guideline-compliant rate in 97.4% (IQR 97.1%–100%) of delivered ventilations, versus 66.7% (IQR 40.9%–77.9%) for the control group. For tidal volume compliance, the intervention group reached 77.5% (IQR 64.9%–83.8%) of ventilations within target compared to 53.4% (IQR 8.4%–66.7%) delivered by the control group. ConclusionsReal-time ventilation feedback increased guideline compliance for both ventilation rate and tidal volume (combined and as individual parameters) in a simulated OHCA setting. Real-time feedback has the potential to improve manual ventilation quality and may allow providers to avoid harmful hyperventilation.
Highlights
Close to 700,000 people suffer sudden out-of-hospital cardiac arrest (OHCA) in the United States and Europe each year and fewer than 15% of those treated by Emergency Medical Services (EMS) personnel survive to hospital discharge.[1,2]
Given the challenge of attaining guideline recommendations for ventilation in OHCA, the impact of hyperventilation on physiology and the improvement in chest compression quality with real-time feedback, this study investigates whether real-time visual ventilation feedback improves manual ventilation quality during resuscitation in a simulated cardiac arrest scenario using a novel flow sensor (AccuVentTM) technology
This randomised controlled trial investigated the use of real-time ventilation feedback during simulated OHCA resuscitation
Summary
Close to 700,000 people suffer sudden out-of-hospital cardiac arrest (OHCA) in the United States and Europe each year and fewer than 15% of those treated by Emergency Medical Services (EMS) personnel survive to hospital discharge.[1,2] In addition to high quality chest compressions, ventilations must be delivered to the patient at an appropriate rate and volume to optimise the flow of oxygenated blood.[3] Myocardial perfusion, cardiac output, and blood flow to the brain have all been shown to decline with hyperventilation, while cerebral and coronary perfusion pressures significantly increase when ventilation rates are reduced.4À8 one study have reported no compromise of haemodynamics during hyperventilation.[9]. Given the challenge of attaining guideline recommendations for ventilation in OHCA, the impact of hyperventilation on physiology and the improvement in chest compression quality with real-time feedback, this study investigates whether real-time visual ventilation feedback improves manual ventilation quality during resuscitation in a simulated cardiac arrest scenario using a novel flow sensor (AccuVentTM) technology. We hypothesize that the use of real-time visual ventilation feedback during CPR will improve ventilation quality delivered by prehospital providers in a simulated OHCA setting
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