Real-world adoption and use of a ventilation feedback device during out-of-hospital cardiac arrest: a population-based observational study from a French prehospital system.

BACKGROUND

Ventilation quality during cardiopulmonary resuscitation remains highly variable despite clear guidelines. Ventilation feedback devices have shown substantial improvements in simulated settings, but real-world implementation data remain limited.We aimed to evaluate real-world adoption and use of a ventilation feedback device during out-of-hospital cardiac arrest (OHCA) management in a French prehospital system.

METHODS

We conducted a retrospective, population-based observational study of adult OHCAs jointly managed by firefighters and Mobile Intensive Care Unit teams in the Doubs region. Cases from 2022 (pre-implementation) and 2024 (post-implementation) were analysed. The primary outcome was device utilisation. Secondary outcomes included return of spontaneous circulation, survival, and neurological status, reported descriptively and exploratorily.

RESULTS

Among 756 patients, 190 (2022) and 166 (2024) met the inclusion criteria. Despite a protocol mandating its systematic use, the device was used in 48/166 (28.9%) cases.Baseline characteristics and resuscitation variables were comparable between groups. Exploratory analyses showed return of spontaneous circulation in 25.0% with device versus 16.1% without (unadjusted odds ratio (OR) = 1.74 confidence interval (CI) 95% [0.77; 3.93]), and survival at day 30 in 10.4% versus 4.2% (unadjusted OR = 2.63 [0.72; 9.53]). Favourable neurological outcome at day 30 was observed in 10.4% versus 3.4% (unadjusted OR = 3.28 [0.84; 12.8]). Given the observational design and limited sample size, these findings should be interpreted as hypothesis-generating.

CONCLUSION

This study highlights a discrepancy between protocol and real-world use of a ventilation feedback device during out-of-hospital cardiac arrest. They underscore the need to better understand implementation factors to inform future studies evaluating clinical effectiveness. Future research should incorporate robust implementation strategies and standardised ventilation parameters.