Cardiac arrest & resuscitation

Real-time feedback during bag-valve-mask ventilation for out-of-hospital cardiac arrest: a before-and-after study (VEntilation during Cardiac Arrest Resuscitation Study, VECARS-2)

ResuscitationPublished before-and-after observational study

Authors' conclusion

Real-time feedback was associated with improved adherence to the guideline-recommended range for Vi, less dispersed Vi,and lower leak volume. Causal inference, clinical significance, and generalizability warrant further evaluation.

Study context

Population
Adults with out-of-hospital cardiac arrest managed by basic life support teams from the Paris Fire Brigade, receiving bag-valve-mask ventilation during 30:2 cardiopulmonary resuscitationpatients analyzed, 4,300 ventilations · without feedback 96 · with feedback 67
Participants
163 adults
Exposure
Bag-valve-mask ventilation quality before and after the implementation of real-time feedback
  • Period-1 (without feedback)n = 96
  • Period-2 (with feedback)n = 67
Outcome
Median insufflated volume (Vi)
Methodological detailstwo sequential adult cohorts
  • Two sequential adult cohorts

Main finding

As reported in the abstract

P = 0.03 for the first ventilation of each cycle

Observational data: associations, not effects.

Further findings

Median expiratory tidal volume (Vt)

P = 0.84

Vi 400-600 mL (share of ventilations)

Vt 400-600 mL (share of ventilations)

OutcomeEstimate
Vi dispersionReduced by 35%mean within-patient IQR ratio 0.65 (95% CI 0.53–0.77)
Leak volume12% lower with feedback · multivariable analysismean ratio 0.88 (95% CI 0.77–0.99)

Original publication

Real-time feedback during bag-valve-mask ventilation for out-of-hospital cardiac arrest: a before-and-after study (VEntilation during Cardiac Arrest Resuscitation Study, VECARS-2). Resuscitation. Published 20 October 2026. doi:10.1016/j.resuscitation.2026.111364

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