The published scope of the 2025 ERC Resuscitation Guidelines mentions ventilation feedback devices (VFDs) multiple times.
Here is why we believe this should lead to strong recommendations in the future guidelines.
Research on ventilation during cardiopulmonary resuscitation (CPR) has been a trending subject in recent years, leading to several publications.
An urgent need for better ventilation quality during CPR
Impact of proper ventilation on CPR outcomes
A key study, Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study by A.H. Idris (1), demonstrated the significance of proper ventilation during CPR. This study was based on transthoracic impedance measurement to estimate tidal volume. Conducted on nearly 2,000 OHCA patients, it showed that a high proportion of patients (60%) were hypoventilated. Moreover, it demonstrated that better ventilation quality, through tidal volume, could triple survival rates. Finally, patients receiving good ventilation had a fourfold higher chance of being discharged from the hospital with good neurological outcomes.
Challenges in ventilation quality among professional rescuers
Similarly, the Paris Fire Brigade (2) observed poor ventilation quality among professional rescuers during CPR. Their study marked the first-ever clinical trial conducted using EOlife. The device was used in a blinded mode to record the quality of manual ventilation. This study included 104 out-of-hospital cardiac arrest (OHCA) patients and recorded a leakage ratio of 41%, leading to low tidal volumes, averaging 291mL. This result is significantly below the current guidelines highlighting the gap between actual practice and the ideal standards.
Ventilation Feedback Devices as a solution for improved CPR Performance
These findings highlight the urgent need for better ventilation quality during CPR. VFDs offer a viable solution for enhancing ventilation consistency. In a 2019 simulation study (3), Khoury et al. investigated the effectiveness of VFDs in improving manual ventilation quality. The study involved both ALS and BLS teams performing ventilation under controlled conditions, comparing standard manual ventilation with the use of VFDs. Results demonstrated that adherence to guidelines improved by over 70% when VFDs were used. Specifically, tidal volume delivery and ventilation rates became more consistent, reducing the risks of both hypoventilation and hyperventilation.
EOlife, the only Ventilation Feedback Device (VFD) to display the volume of gas reaching the patient’s lungs (Tidal Volume).
CE-marked and FDA-cleared medical device enabling real-time measurement of insufflated volume, tidal volume, and ventilation frequency, along with visual feedback to deliver ventilation in accordance with ERC or AHA recommendations.
VFDs, the key to enhance CPR training
In addition to being critically useful in clinical practice, VFDs also significantly enhance CPR training by addressing critical gaps in performance.
Poor adherence to pediatric ventilation guidelines in training
A simulation study by S. Lemoine (4) in 2024 highlighted the poor adherence to pediatric ventilation guidelines during training, revealing that only 13% of professional BLS participants ventilated the pediatric manikin within the correct volume range. In contrast, 25% of participants hypoventilated, and a staggering 62% hyperventilated, underscoring the challenges in achieving accurate ventilation during CPR training.
Instructor misjudgment in ventilation quality assessments
Additionally, a 2024 letter by D’Agostino et al. (5) exposed a critical issue in instructor assessments of ventilation accuracy. Despite only 5% of ACLS course participants ventilating correctly according to EOlife X assessment, instructors believed that all participants performed well, with 100% of them thought to have met the required standards. This discrepancy emphasizes the importance of VFDs in both training and evaluation, ensuring that ventilation techniques are properly monitored and improved.
Effectiveness of ventilation feedback devices in training
Finally, a study by J. Finney, presented at PAS 2024 (6), demonstrated the significant impact of VFDs on pediatric ventilation training outcomes. Participants showed nearly a 40% improvement in ventilation rates, and tidal volume delivery increased by 60% when using the EOlife X compared to standard practice. This highlights the effectiveness of VFDs in improving both the accuracy and efficiency of CPR training.
EOlife X, the ultimate tool for High-Performance Ventilation training.
Training tool allowing measurement and recording of insufflated volume, tidal volume, manual ventilation frequency, in real time, to practice ventilation in accordance with ERC and AHA recommendations. EOlife X enables training on adult and pediatric (> 1 year) manikins.
With strong evidence from clinical practice and training, VFDs are set to transform resuscitation. Their role in improving ventilation quality is undeniable. Consequently, the 2025 ERC Resuscitation Guidelines are expected to incorporate these advancements.
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References
(1) Idris, A. H., Aramendi Ecenarro, E., Leroux, B., et al. (2023). Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation, 148(23), 1847–1856.
(2) Lemoine, F., Jost, D., Tassart, B., et al. (2024). Evaluation of ventilation quality by basic life support teams during out-of-hospital cardiac arrest: preliminary results from a prospective observational study—the VECARS study. Resuscitation, 03:S215
(3) Khoury, A., De Luca, A., Sall, F. S., et al. (2019). Ventilation feedback device for manual ventilation in simulated respiratory arrest: a crossover manikin study. Scandinavian journal of trauma, resuscitation and emergency medicine, 27(1), 93.
(4) Lemoine, S., Jost, D., Petermann, A., et al. (2024). Compliance with Pediatric Manual Ventilation Guidelines by Professional Basic Life Support Rescuers During Out-of-Hospital Cardiac Arrest: A Simulation Study. Resuscitation, 185, 110240.
(5) D’Agostino, F., et al. (2024). Are Instructors Correctly Gauging Ventilation Competence Acquired by Manual Ventilation Trainees? Resuscitation, 185, 110240.
(6) Finney, J., et al. (2024). PREVENT: The Pediatric EMS Ventilation Pilot Simulation Trial. Pediatric Academic Societies Meeting, Abstract P-411.