Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation, 148(23), 1847–1856. https://doi.org/10.1161/CIRCULATIONAHA.123.065561 Dr. Ahamed H. Idris et al.
Points
- Approximately 1/3 of patients with acute decompensated heart failure (ADHF) are discharged with persistent congestion, which is associated with higher mortality and heart failure readmissions.
- Worsening renal function (WRF) occurs in about 50% of ADHF patients, increasing the risk of adverse outcomes.
- A multicenter, prospective registry enrolled 237 patients with ADHF, WRF, and persistent congestion to study current treatments and outcomes.
- Patients with persistent congestion had a high burden of clinical events during hospitalization, including intensive care unit transfers, intubation, left ventricular assist device implantation, and dialysis.
- At the 90-day follow-up, 33% of patients were readmitted for ADHF or died, highlighting the need for novel treatment strategies for this high-risk population.
Summary
This research paper aimed to investigate the incidence of lung inflation with bag-valve-mask ventilation during early cardiopulmonary resuscitation (CPR) and its association with outcomes after out-of-hospital cardiac arrest. The study analyzed data from patients enrolled in the Resuscitation Outcomes Consortium CCC study, specifically focusing on those assigned to the 30:2 CPR arm. The incidence of ventilation and outcomes were compared between two groups: patients with ventilation waveforms in less than 50% of pauses (group 1) and those with waveforms in 50% or more (group 2).
Among the 1976 patients studied, it was found that lung inflation with bag-valve-mask ventilation during 30:2 CPR occurred infrequently. Group 1, which had ventilation waveforms in less than 50% of pauses, had a median of 12 pauses and two ventilations per patient. In contrast, group 2, with waveforms in 50% or more of pauses, had 12 pauses and 12 ventilations per patient. Notably, group 2 demonstrated significantly higher rates of prehospital return of spontaneous circulation, survival to hospital discharge, and survival with favorable neurological outcomes compared to group 1. These associations remained significant even after adjusting for confounding factors.
The findings of this study suggest that achieving lung inflation in 50% or more of pauses during 30:2 CPR is associated with improved outcomes in out-of-hospital cardiac arrest patients. This highlights the potential importance of effective bag-valve-mask ventilation during CPR. Further research and consideration may be warranted to explore strategies for optimizing ventilation delivery during CPR and its impact on patient outcomes.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065561
References Idris, A. H., Aramendi Ecenarro, E., Leroux, B., Jaureguibeitia, X., Yang, B. Y., Shaver, S., Chang, M. P., Rea, T., Kudenchuk, P., Christenson, J., Vaillancourt, C., Callaway, C., Salcido, D., Carson, J., Blackwood, J., & Wang, H. E. (2023). Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation, 148(23), 1847–1856. https://doi.org/10.1161/CIRCULATIONAHA.123.065561
