{"doi":"10.1161/circulationaha.123.065561","title":"Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study","abstract":"BACKGROUND: Few studies have measured ventilation during early cardiopulmonary resuscitation (CPR) before advanced airway placement. Resuscitation guidelines recommend pauses after every 30 chest compressions to deliver ventilations. The effectiveness of bag-valve-mask ventilation delivered during the pause in chest compressions is unknown. We sought to determine: (1) the incidence of lung inflation with bag-valve-mask ventilation during 30:2 CPR; and (2) the association of ventilation with outcomes after out-of-hospital cardiac arrest. METHODS: We studied patients with out-of-hospital cardiac arrest from 6 sites of the Resuscitation Outcomes Consortium CCC study (Trial of Continuous Compressions versus Standard CPR in Patients with Out-of-Hospital Cardiac Arrest). We analyzed patients assigned to the 30:2 CPR arm with ≥2 minutes of thoracic bioimpedance signal recorded with a cardiac defibrillator/monitor. Detectable ventilation waveforms were defined as having a bioimpedance amplitude ≥0.5 Ω (corresponding to ≥250 mL V T ) and a duration ≥1 s. We defined a chest compression pause as a 3- to 15-s break in chest compressions. We compared the incidence of ventilation and outcomes in 2 groups: patients with ventilation waveforms in <50% of pauses (group 1) versus those with waveforms in ≥50% of pauses (group 2). RESULTS: Among 1976 patients, the mean age was 65 years; 66% were male. From the start of chest compressions until advanced airway placement, mean±SD duration of 30:2 CPR was 9.8±4.9 minutes. During this period, we identified 26 861 pauses in chest compressions; 60% of patients had ventilation waveforms in <50% of pauses (group 1, n=1177), and 40% had waveforms in ≥50% of pauses (group 2, n=799). Group 1 had a median of 12 pauses and 2 ventilations per patient versus group 2, which had 12 pauses and 12 ventilations per patient. Group 2 had higher rates of prehospital return of spontaneous circulation (40.7% versus 25.2%; P <0.0001), survival to hospital discharge (13.5% versus 4.1%; P <0.0001), and survival with favorable neurological outcome (10.6% versus 2.4%; P <0.0001). These associations persisted after adjustment for confounders. CONCLUSIONS: In this study, lung inflation occurred infrequently with bag-valve-mask ventilation during 30:2 CPR. Lung inflation in ≥50% of pauses was associated with improved return of spontaneous circulation, survival, and survival with favorable neurological outcome.","journal":"Circulation","year":2023,"id":317396,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":79,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9604,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":406537,"name":"Elisabete Aramendi","orcid":"0000-0002-6409-1429","position":1,"is_corresponding":false},{"id":286258,"name":"Brian G. Leroux","orcid":"0000-0002-8921-7921","position":2,"is_corresponding":false},{"id":1022816,"name":"Xabier Jaureguibeitia","orcid":"0000-0002-8667-6399","position":3,"is_corresponding":false},{"id":942979,"name":"Betty Yang","orcid":"0000-0003-0197-925X","position":4,"is_corresponding":false},{"id":1023517,"name":"Sarah Shaver","orcid":null,"position":5,"is_corresponding":false},{"id":1022817,"name":"Mary P. Chang","orcid":"0000-0001-8714-5090","position":6,"is_corresponding":false},{"id":1023518,"name":"Tom Rea","orcid":null,"position":7,"is_corresponding":false},{"id":286272,"name":"Peter J. Kudenchuk","orcid":"0000-0003-1855-1102","position":8,"is_corresponding":false},{"id":286267,"name":"Jim Christenson","orcid":"0000-0001-7126-6314","position":9,"is_corresponding":false},{"id":429676,"name":"Christian Vaillancourt","orcid":"0000-0002-8563-4656","position":10,"is_corresponding":false},{"id":98909,"name":"Clifton W. Callaway","orcid":"0000-0002-3309-1573","position":11,"is_corresponding":false},{"id":514675,"name":"David D. Salcido","orcid":"0000-0002-3735-8167","position":12,"is_corresponding":false},{"id":1023519,"name":"Jonas Carson","orcid":null,"position":13,"is_corresponding":false},{"id":394999,"name":"Jennifer Blackwood","orcid":"0000-0003-1514-2186","position":14,"is_corresponding":false},{"id":295517,"name":"Henry E. Wang","orcid":"0000-0002-4738-0093","position":15,"is_corresponding":false},{"id":286268,"name":"Ahamed H. Idris","orcid":"0000-0001-7113-6499","position":0,"is_corresponding":true}],"reference_count":34,"raw_metadata":null,"created_at":"2026-07-19T01:06:50.336418Z","pmid":"37952192","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":[]}