Study reveals ventilation gaps during CPR that could improve survival rates
A major study of over 28,000 CPR ventilations found significant differences in how much air reaches patient lungs depending on the airway device used. The findings could help emergency services protocols and device manufacturers optimize lifesaving procedures, potentially improving cardiac arrest survival outcomes across healthcare systems.
Originaltitel: Ventilation parameters during Advanced Life Support in cardiac arrest (CAvent): A multicentre observational cohort study.
Ventileringsparametrar vid hjärtmassage varierar drastiskt mellan olika airway-tekniker — en insikt som kan påverka val av utrustning och träningsprogram i akutsjukvården. CAvent-studien mätte ventilationen hos 241 hjärtstoppspatienter (28 120 ventileringar) i Sverige och Nederländerna mellan 2019 och 2025. Resultaten visar att säck-mask-ventilation (BVM) producerar endast 186 ml expiratorisk tidalvolym, medan supraglottisk airway (SAD) ger 395 ml och endotrakeala tuber (ETT) 404 ml vid asynkron ventilation. Asynkron ETT-ventilation genererade högst luftvägstryck (51 cmH2O) med långvarig övertryck. Forskare från Uppsala universitet och Amsterdam UMC påpekar att resultaten understrukar behovet av standardiserad mätning av ventileringsparametrar i akut vård. Regulatorer och inköpare kan använda dessa data för att optimera valet mellan airway-modeller och justera träningsprotokollers fokus.
INTRODUCTION: Despite the critical role of ventilation during CPR, insights into the procedure are limited. This study aimed to describe and compare ventilation parameters across different ventilation modes and airway modalities during CPR with manual ventilation. METHODS: The Cardiac Arrest ventilation study (CAvent) was a multicentre, prospective observational cohort study in adult patients with cardiac arrest across five Advanced Life Support systems in Sweden and the Netherlands. Ventilation parameters were measured with a portable pneumotachograph and capnography device. Parameters were compared between ventilation modes (synchronous versus asynchronous) and airway modalities (bag-valve-mask (BVM), supraglottic airway device (SAD), and endotracheal tube (ETT)) using mixed-effects regression models. RESULTS: Between May 2019 and August 2025, 241 cardiac arrest patients yielded 28 120 ventilations for analysis. Ventilations caused an expiratory tidal volume of 186 (95% CI 104-260) ml in synchronous BVM, 395 (316-475) ml in synchronous SAD, 333 (227-437) ml in asynchronous SAD, and 404 (371-435) ml in asynchronous ETT ventilations. Asynchronous ETT ventilation was associated with the longest time of airway pressure >30 cmH2O at 5·8 (5·1-6·4) sec·min-1 and highest peak inspiratory pressure, 51·0 (95% CI 48·7-53·1) cmH2O. CONCLUSIONS: Ventilation parameters during CPR vary substantially across manual ventilation modes and airway modalities. Specifically, BVM ventilations demonstrate limited efficacy, SAD ventilations yield consistent tidal volumes and pressures across modes, with leakage increasing over time, while asynchronous ETT ventilation generates high airway pressures. This highlights a need for standard measurement of ventilation parameters in CPR-related studies and clinical practice.