EP10 The impact of introducing real time feedback on ventilation rate and volume by ambulance clinicians in the North East in a simulated cardiac arrest scenario: the VANZ study

Abstract

BackgroundAdequate ventilation is an important aspect of cardiopulmonary resuscitation (CPR). Research suggests 80% of caregivers hyperventilate during CPR and that feedback improves compliance with ventilation guidelines. Hyperventilation is associated with increased intrathoracic pressure, impaired haemodynamics and cerebral vasoconstriction and therefore can be deleterious to survival. VANZ aimed to determine if compliance with European Resuscitation Council (ERC) ventilation guidelines could be improved using a real time ventilation feedback deviceMethodsParticipants simulated a two-minute cardiac arrest scenario using a manikin and defibrillator without ventilation feedback. Researchers demonstrated the ventilation feedback device and participants practiced using it. The two-minute scenario was then repeated with ventilation feedback. The ventilation rate, volume and CPR quality were recorded during each scenario. The primary outcome was based on achieving ≥50% compliance with ERC ventilation guidelines of ventilating at 8-12 breaths per minute and 500-600ml per breath. Following the study participants were asked to complete a short survey on the ventilation feedback deviceResultsDuring September 2020 106 participants (58% male, mean age 42, 74% paramedics) completed the study. The primary outcome showed a significant improvement from 9% of participants achieving ≥50% compliance without feedback to 91% of participants achieving ≥50% compliance with feedback (McNemars test p<0.0001). Survey data from participants was overwhelmingly positive about the ventilation feedback device.ConclusionsUse of real time ventilation feedback during CPR significantly improved participants ability to deliver ventilations compliant with ERC guidelines in a simulated scenario. The fact that this was a manikin study is a limitation but the low rate of compliance with ventilation guidelines without feedback raises questions about ventilation quality when CPR is performed on patients. Future research should examine the quality of ventilations performed on patients, the ability of feedback to improve compliance with guidelines and the impact this has on patient outcomes.