Ventilation Monitoring in Out-of-Hospital Cardiac Arrest Care

Aufderheide, TP; Colella, MR; Weston, BW; Labinski, J; Mattrisch, L; Jasti, J; Pirrallo, RG; Szabo, A; Chunara, F; Sebastian, PS; Engel, TW; Chinn, M; Lenz, T; Liu, JM; Mausner, K; Monti, CE; Gottula, AL; Kosmopoulos, M; Kalra, R; Bartos, JA; Yannopoulos, D; Grawey, T

doi:10.1016/j.resuscitation.2026.111372

Acute cardiac care & resuscitation

Ventilation Monitoring in Out-of-Hospital Cardiac Arrest Care

ResuscitationPublished 29 Oct 2026Prospective, Before/After quality assurance study

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Authors' conclusion

Real BVM Help® was associated with statistically significant and clinically meaningful improvement in adherence to AHA ventilation guidelines. ETCO2 monitoring failed to approach both rate and tidal volume guideline adherence with a lower-than-target tidal volume being the most common parameter delivered out-of-target (58.2%). Ventilation rate and tidal volume monitoring with real-time feedback should be considered during treatment of cardiac arrest.

Study context

Population: Adults with out-of-hospital cardiac arrest treated by Milwaukee County Emergency Medical Services and Kenosha Fire in Wisconsinpatients entered 9/29/22–12/22/23
Participants: 278 adults

Exposure: (Before) end tidal carbon dioxide [ETCO2] to monitor ventilations - Real BVM Help® applied but blinded versus (After) Real BVM Help®
Beforen = 148
Aftern = 130
Outcome: Mean per-person proportion (%) of ventilations in-target for rate, tidal volume, and both rate and tidal volume

Main finding

As reported in the abstract

Group	In-target for rate	In-target for tidal volume	In-target for rate and tidal volume
Before	47.7±25.1%	15.3±15.4%	7.5±9.6%
After	74.4±24.1%	45.4±23.8%	39.0±23.3%

In-target for rate

Before47.7±25.1%

After74.4±24.1%

In-target for tidal volume

Before15.3±15.4%

After45.4±23.8%

In-target for rate and tidal volume

Before7.5±9.6%

After39.0±23.3%

Significantly higher in the After Group for rate, tidal volume, and rate and tidal volume: P < 0.0001

Observational data: associations, not effects.

Further findings

Baseline characteristics

Average age: 62.3±16.7 years
Male: 185 (67%)

Before Group, all ventilations monitored with ETCO2 (N=22,037 ventilations)

In-target for rate: 43.8%
In-target for tidal volume: 13.5%
In-target for rate and tidal volume: 6.8%
Lower-than-target tidal volume delivered: 58.2%

Per-ventilation analysis, Before Group only

Original publication

Ventilation Monitoring in Out-of-Hospital Cardiac Arrest Care. Resuscitation. Published 29 October 2026. doi:10.1016/j.resuscitation.2026.111372

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