{"doi":"10.1111/acem.13927","title":"Outcomes With the Use of Bag–Valve–Mask Ventilation During Out‐of‐hospital Cardiac Arrest in the Pragmatic Airway Resuscitation Trial","abstract":"BACKGROUND: While emergency medical services (EMS) often use endotracheal intubation (ETI) or supraglottic airways (SGA), some patients receive only bag-valve-mask (BVM) ventilation during out-of-hospital cardiac arrests (OHCA). Our objective was to compare patient characteristics and outcomes for BVM ventilation to advanced airway management (AAM) in adults with OHCA. METHODS: Using data from the Pragmatic Airway Resuscitation Trial, we identified patients receiving AAM (ETI or a SGA), BVM ventilation only (BVM-only), and BVM ventilation as a rescue after at least one failed attempt at advanced airway placement (BVM-rescue). The outcomes were return of spontaneous circulation (ROSC), 72-hour survival, survival to hospital discharge, neurologically intact survival (Modified Rankin Scale ≤ 3), and the presence of aspiration on a chest radiograph. Comparisons were made using generalized mixed-effects models while adjusting for age, sex, initial rhythm, EMS-witnessed status, bystander cardiopulmonary resuscitation, response time, study cluster, and advanced life support first on scene. RESULTS: Of 3,004 patients enrolled, there were 282 BVM-only, 2,129 AAM, and 156 BVM-rescue patients with complete covariates. Shockable initial rhythms (34% vs. 18.6%) and EMS-witnessed arrests (21.6% vs. 11.3%) were more likely in BVM-only than AAM but similar between BVM-rescue and AAM. Compared to AAM, BVM-only patients had similar ROSC (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 0.96 to 1.73), but higher 72-hour survival (OR = 1.96, 95% CI = 1.42 to 2.69), survival to discharge (OR = 4.47, 95% CI = 3.03 to 6.59), and neurologically intact survival (OR = 7.05, 95% CI = 4.40 to 11.3). Compared to AAM, BVM-rescue patients had similar ROSC (OR = 0.73, 95% CI = 0.47 to 1.12) and 72-hour survival (OR = 1.08, 95% CI = 0.66 to 1.77) but higher survival to discharge (OR = 2.15, 95% CI = 1.17 to 3.95) and neurologically intact survival (OR = 2.64, 95% CI = 1.20 to 5.81). Aspiration incidence was similar. CONCLUSIONS: Bag-valve-mask-only ventilation is associated with improved OHCA outcomes. Despite similar rates of ROSC and 72-hour survival, BVM-rescue ventilation was associated with improved survival to discharge and neurologically intact survival compared to successful AAM.","journal":"Academic Emergency Medicine","year":2020,"id":99066,"datarank":0.515098080672772,"base_score":3.4339872044851463,"endowment":3.4339872044851463,"self_citation_contribution":0.515098080672772,"citation_network_contribution":0.0,"self_endowment_contribution":0.515098080672772,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":30,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9305,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":450994,"name":"Robert H. Schmicker","orcid":"0000-0001-7100-7910","position":1,"is_corresponding":false},{"id":488142,"name":"Shannon W. Stephens","orcid":"0000-0001-5898-5170","position":2,"is_corresponding":false},{"id":411336,"name":"Jestin N. Carlson","orcid":"0000-0003-1932-3670","position":3,"is_corresponding":false},{"id":98909,"name":"Clifton W. Callaway","orcid":"0000-0002-3309-1573","position":4,"is_corresponding":false},{"id":489378,"name":"Heather Herren","orcid":null,"position":5,"is_corresponding":false},{"id":286268,"name":"Ahamed H. Idris","orcid":"0000-0001-7113-6499","position":6,"is_corresponding":false},{"id":286266,"name":"George Sopko","orcid":"0000-0002-5482-8992","position":7,"is_corresponding":false},{"id":430608,"name":"Juan Carlos Puyana","orcid":"0000-0003-4284-4693","position":8,"is_corresponding":false},{"id":286257,"name":"Mohamud Daya","orcid":"0000-0002-6910-8293","position":9,"is_corresponding":false},{"id":295517,"name":"Henry E. Wang","orcid":"0000-0002-4738-0093","position":10,"is_corresponding":false},{"id":439216,"name":"Matthew Hansen","orcid":"0000-0003-2958-6423","position":11,"is_corresponding":false},{"id":286263,"name":"Joshua R. Lupton","orcid":"0000-0003-4136-6095","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T22:37:35.547042Z","pmid":"32220129","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}