Emergency Intubation Bests BMV for CPR

Bag-mask ventilation (BMV) fails to improve on endotracheal intubation (ETI) in out-of-hospital cardiac arrest patients, according to a new study.

Researchers at Avicenne Hospital (Bobigny, France), Diderot University (Paris, France), and other institutions conducted a prospective, randomized trial, which compared the impact of airway management with BMV versus ETI on survival with healthy brain function. The study included 2,043 out-of-hospital cardiac arrest patients from 20 centers in France and Belgium who were randomized to receive BMV or ETI during cardiopulmonary resuscitation (CPR). The primary endpoint of the study was survival with good neurological function at 28 days.

The results revealed the same rate of survival with good neurological outcome at day 28 in both groups (4.2% with BMV versus 4.3% with ETI). However, analysis showed that the BMV technique also failed in 6.7% of patients, compared to a lower failure rate of just 2.1% with ETI. In addition, there was a much greater incidence of regurgitation and/or aspiration with BMV (15.2%), as compared to ETI (7.5%). The study was presented at the European Society of Cardiology (ESC) annual conference, held during August 2017 in Barcelona (Spain).

“We were surprised by the much higher incidence of failure of the BMV technique compared with ETI. BMV appears less safe than ETI as a means of ventilation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest,” said senior author Professor Frederic Adnet, MD, PhD, of Avicenne Hospital. “Thus, we cannot recommend BMV as the standard method to ventilate out-of-hospital cardiac arrest patients during cardiopulmonary resuscitation.”

BMV is a basic airway management technique that allows for oxygenation and ventilation of patients until a more definitive airway can be established, and in cases where ETI or other definitive control of the airway is not possible. Successful BMV requires a good seal, a patent airway, and technical skill. Bag masks come in many sizes, including newborn, infant, child, and adult, and include several types, such as bags with a pressure valve, or one-way expiratory valves to prevent the entry of room air; these allow for delivery of greater than 90% oxygen to ventilated and spontaneously breathing patients.

Related Links:
Avicenne Hospital
Diderot University