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Just about everyone who works in paramedicine long enough eventually ends up with a story of someone trying to ventilate a patient in cardiac arrest using the bag on a nonrebreather.  The two medics whose stories I remember best happen to involve nursing home staff in one case, and a cop in the other.  Lately, however, I’m wondering if those folks were on to something.

There’s been a big push lately to improve the quality and number of compressions during CPR, and one way to do so is to use passive ventilations rather than a BVM–that is, to throw a nonrebreather on the patient and allow the chest compressions to move a little air.

However, even though this idea is a few years old, it’s still a big change from the old way of doing things.  When such a protocol was instituted in Arizona in January 2005, medics were allowed to bag the patient at their discretion.  Now, an analysis of the first few years of data is showing us what happened to both groups of patients.  Counterintuitively, some patients who got a nonrebreather did significantly better:  among witnessed shockable arrests, no-BVM patients had 38.2% neurologically intact survival compared to 25.8%.  However, patients in nonshockable rhythms or who had an unwitnessed VF/VT arrest were no better off–in fact, the survival for those patients was lower in the no-BVM group, although the numbers didn’t reach statistical significance.

Unfortunately, this article isn’t the kind of practice-changing data that would put everybody on track to start using minimally-interrupted compressions:  it was retrospective data, and the patients weren’t randomly put into treatment groups–there could be some hidden bias among providers in deciding who gets BVM or not.  By the same token, it’s strong enough to stimulate more trials, and possibly even help affect what happens at next year’s ILCOR meeting.  I know I’m certainly looking forward to what the 2010 CPR guidelines look like.

Filed under: EMS Research