Abstract 298: Efficacy of Bag-Mask Ventilation for Ventricular Fibrillation Sudden Cardiac Arrest
Background: If bag-mask ventilation is adequate, an advanced airway is not urgently required. Although rescuers may defer insertion of an advanced airway until the patient fails to respond to initial cardiopulmonary resuscitation (CPR) and defibrillation attempts or has return of spontaneous circulation (ROSC), its effects and optimal timing remain unclear.
Methods: An observational study was performed in 670,313 patients who had out-of-hospital cardiac arrest (OHCA) in Japan and received CPR between January 1, 2005 and December 31, 2010. Of these patients, 9,720 in whom age was from 18 to 74 years, OHCA was cardiogenic, the scene of OHCA was witnessed, bystander CPR was performed, and initial rhythm was ventricular fibrillation (VF) were studied. The subjects were divided into two groups according to the method used for airway management by emergency medical service (EMS) personnel: 5,358 who used a bag-valve mask (bag-mask ventilation group: BMV group) and 4,362 who used an advanced airway including a supraglottic airway device and endotracheal tube (advanced airway management group: AAM group). The rates of ROSC from the initiation of EMS-CPR to arrival at the hospital were compared. Next, subjects who did not have ROSC within 45 minutes before arrival at the hospital were divided into two groups, the pre-hospital non-ROSC BMV group (N=3,092) and the pre-hospital non-ROSC AAM group (N=3,291), and neurologic outcomes at 30 days were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1 or 2.
Results: The rate of ROSC from the initiation of EMS-CPR to arrival at the hospital was higher (41% vs. 21%, p<0.01) in the BMV group than in the AAM group. The rate of favorable outcomes was higher (8% vs. 3%, p<0.01) in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AAM group. In particular, the rate of favorable outcomes was higher in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AAM group during the first 20 minutes after the initiation of EMS-CPR.
Conclusions: In patients with VF sudden cardiac arrest, the use of a bag-valve mask for airway management increases the rates of ROSC and favorable outcomes, particularly during the initial period from EMS-CPR to arrival at the hospital.
- © 2012 by American Heart Association, Inc.