Putting the ‘P’ back in CPR to save more lives

For decades, the first 15 minutes of cardiac arrest management have been mostly focused on chest compressions, with the objective being to maximise blood flow by limiting interruptions and minimising ‘no-flow’ time. This has led to well-established guidelines, prolific research and innovations like mechanical compression devices and depth sensors to enhance chest compression quality. Finally, bystander CPR is more common than ever.

Yet despite these efforts, neurological outcomes after cardiac arrest have remained stubbornly unchanged over the past 30 years.

What did we miss?

A recent study presented at the 2024 American Heart Association conference in Chicago revealed a critical oversight: by prioritising compressions while neglecting high-quality ventilation, patient survival has been severely compromised.

Another study went even further, demonstrating that effective tidal volume delivery during CPR could triple survival and quadruple the likelihood of good neurological outcomes.

So where do we stand in terms of ventilation quality?

Unfortunately, not in a good place. Studies show that nearly 60% of patients are hypoventilated during CPR – a staggering figure that represents a serious threat to survival. The causes are numerous: mask leakage is a common culprit but improperly positioned endotracheal tubes or even laryngeal masks can result in similar issues.

This problem has been well documented. In a study presented by the Paris Fire Brigade during the 2024 ERC congress in Athens, Dr. Daniel Jost and colleagues found that out-of-hospital cardiac arrest (OHCA) patients received a median tidal volume of only 250mL – far below the 500 mL recommended in international guidelines. Mask leakage accounted for up to 40% of insufflated volume.

The problem isn’t limited to firefighters. A study conducted at Besançon University Hospital revealed that only 7.5% of healthcare professionals, including Emergency Medical Technicians (EMT), nurses, and physicians, were able to deliver a correct tidal volume during manual ventilation.

What’s the solution?

New technologies are emerging to meet this challenge. Ventilation Feedback Devices (VFDs) are designed to monitor ventilation quality in real time, providing data on tidal volume, ventilation rate, and mask leakage levels. They guide users to adjust their technique, such as mask repositioning, to ensure that users achieve an effective mask seal and in turn, deliver effective and safe ventilation volumes.

By monitoring tidal volumes and ventilation rates we can significantly reduce the risk of both Hyper and Hypo-ventilation.

One of the most recognised and effective VFDs currently available is the EOlife from Archeon Medical.

This compact and intuitive tool has been shown to improve ventilation quality by up to 70%, regardless of the user’s professional background. By displaying real-time tidal volume and leak information, it allows rescuers to optimise ventilation immediately.

Improving outcomes in cardiac arrest demands integrating VFDs into standard CPR protocols: this is no longer optional, but essential.

These devices offer a pathway to standardised, high-quality ventilation that could transform the chance of survival for cardiac arrest patients worldwide.

This conclusion is gaining support among experts. In the European Journal for Emergency Medicine (EJEM), we recently highlighted that promoting the adoption of ventilation feedback devices (VFDs) in both clinical practice and training settings can lead to better patient outcomes.

It’s time to act. Let’s bring ventilation back to the forefront of resuscitation, equip our teams with the tools they need, and give our patients the best possible chance of survival. Together, we can raise the standard of cardiopulmonary resuscitation, by putting the ‘P’ back to the centre of ‘CPR’, where it belongs.

The industry will once again be gathering at the NEC, Birmingham for The Emergency Services Show, co-located with The Emergency Tech Show, on 17-18 September, check out the full exhibitor list here. You can find Archeon Medical, represented by Ortus Technologies, in Hall 5, Stand F190.