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Resuscitation guidelines recommend pauses after every 30 chest compressions to deliver ventilations. The effectiveness of bag-valve-mask ventilation delivered during the pause in chest compressions is unknown. We sought to determine: (1) the incidence of lung inflation with bag-valve-mask ventilation during 30:2 CPR; and (2) the association of ventilation with outcomes after out-of-hospital cardiac arrest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      We studied patients with out-of-hospital cardiac arrest from 6 sites of the Resuscitation Outcomes Consortium CCC study (Trial of Continuous Compressions versus Standard CPR in Patients with Out-of-Hospital Cardiac Arrest). We analyzed patients assigned to the 30:2 CPR arm with \u22652 minutes of thoracic bioimpedance signal recorded with a cardiac defibrillator\/monitor. Detectable ventilation waveforms were defined as having a bioimpedance amplitude \u22650.5 \u03a9 (corresponding to \u2265250 mL V\n                      <jats:sub>T<\/jats:sub>\n                      ) and a duration \u22651 s. We defined a chest compression pause as a 3- to 15-s break in chest compressions. We compared the incidence of ventilation and outcomes in 2 groups: patients with ventilation waveforms in &lt;50% of pauses (group 1) versus those with waveforms in \u226550% of pauses (group 2).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1976 patients, the mean age was 65 years; 66% were male. From the start of chest compressions until advanced airway placement, mean\u00b1SD duration of 30:2 CPR was 9.8\u00b14.9 minutes. During this period, we identified 26\u2009861 pauses in chest compressions; 60% of patients had ventilation waveforms in &lt;50% of pauses (group 1, n=1177), and 40% had waveforms in \u226550% of pauses (group 2, n=799). Group 1 had a median of 12 pauses and 2 ventilations per patient versus group 2, which had 12 pauses and 12 ventilations per patient. Group 2 had higher rates of prehospital return of spontaneous circulation (40.7% versus 25.2%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001), survival to hospital discharge (13.5% versus 4.1%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001), and survival with favorable neurological outcome (10.6% versus 2.4%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). These associations persisted after adjustment for confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In this study, lung inflation occurred infrequently with bag-valve-mask ventilation during 30:2 CPR. Lung inflation in \u226550% of pauses was associated with improved return of spontaneous circulation, survival, and survival with favorable neurological outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.123.065561","type":"journal-article","created":{"date-parts":[[2023,11,12]],"date-time":"2023-11-12T09:45:07Z","timestamp":1699782307000},"page":"1847-1856","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":89,"title":["Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study"],"prefix":"10.1161","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7113-6499","authenticated-orcid":true,"given":"Ahamed H.","family":"Idris","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (A.H.I, B.Y.Y., S.S., M.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabete","family":"Aramendi Ecenarro","sequence":"additional","affiliation":[{"name":"Department of Communications Engineering, University of the Basque Country, Bilbao, Spain (E.A.E., X.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Leroux","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (B.L., J.C.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8667-6399","authenticated-orcid":true,"given":"Xabier","family":"Jaureguibeitia","sequence":"additional","affiliation":[{"name":"Department of Communications Engineering, University of the Basque Country, Bilbao, Spain (E.A.E., X.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty Y.","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (A.H.I, B.Y.Y., S.S., M.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Shaver","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (A.H.I, B.Y.Y., S.S., M.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary P.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas (A.H.I, B.Y.Y., S.S., M.P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Rea","sequence":"additional","affiliation":[{"name":"Department of Medicine (Emergency Medicine) (T.R.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1855-1102","authenticated-orcid":true,"given":"Peter","family":"Kudenchuk","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology) (P.K.), University of Washington, Seattle."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Christenson","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (B.L., J.C.), University of Washington, Seattle."},{"name":"Department of Emergency Medicine, University of British Columbia, Vancouver, Canada (J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8563-4656","authenticated-orcid":true,"given":"Christian","family":"Vaillancourt","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Ottawa, Ontario, Canada (C.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifton","family":"Callaway","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh, PA (C.C., D.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3735-8167","authenticated-orcid":true,"given":"David","family":"Salcido","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh, PA (C.C., D.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Carson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Blackwood","sequence":"additional","affiliation":[{"name":"Public Health-Seattle &amp; 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