Abstract 12885: Efficacy of Bag-valve-mask Ventilation for Ventricular Fibrillation Sudden Cardiac Arrest
Background: If bag-valve-mask (BVM) ventilation is adequate, an advanced airway management (AAM) 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 797,422 patients who had out-of-hospital cardiac arrest (OHCA) in Japan and received CPR from 2005 to 2011. Of these patients, 5,037 in whom age was 18-75 years, OHCA was cardiogenic, the scene of OHCA was witnessed, bystander hands-only CPR was performed, initial rhythm was ventricular fibrillation (VF), and peripheral venous access was not gained by emergency medical service (EMS) personnel were studied. The subjects were divided into two groups according to the method used for airway management by EMS personnel: 3,248 who used a BVM (BVM group) and 1,789 who used an AAM including a supraglottic airway device and endotracheal tube (AAM group). The rates of pre-hospital ROSC were compared. Next, subjects who did not have pre-hospital ROSC were divided into two groups, BVM’ group (N=1,864) and AAM’ group (N=1,420), 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 pre-hospital ROSC was higher (43% vs. 21%, p≤0.01) in the BVM group than in the AAM group. The rate of favorable outcomes was higher (8% vs. 4%, p≤0.01) in the BVM’ group than in the AAM’ group. In particular, the rate of favorable outcomes was higher in the BVM’ group than in the AAM’ group during the first 15 minutes after the initiation of EMS-CPR.
Conclusions: In patients with VF sudden cardiac arrest patients, the use of a BVM for airway management increases the rates of ROSC and favorable outcomes, particularly during the initial period from EMS-CPR start to arrival at the hospital.
- © 2013 by American Heart Association, Inc.