A randomised, exploratory study comparing a single episode of feedback with regular feedback and no feedback on ambulance clinician bag-valve-mask ventilation during a simulated cardiac arrest over a six-month time frame.

Introduction: Ventilation with a bag-valve-mask is a standard part of cardiopulmonary resuscitation (CPR) performed by ambulance clinicians. Ventilation quality has received little attention until recently, when ventilation feedback devices (VFDs) became available. Evidence suggests that clinicians struggle to ventilate according to guidelines without feedback and that a VFD improves ventilation quality. This study explored the impact of regular VFD use compared with a single episode of VFD use and no VFD use on ventilation quality during simulated CPR across a six-month period.

Methods: The study comprised a single-site, exploratory, randomised controlled trial conducted in North East Ambulance Service NHS Foundation Trust. Participants completed six-minute CPR scenarios, with ventilation quality recorded, repeated three times over six months. Participants were randomised 1:1:1 to ventilation feedback at each session, feedback at the first session only or no feedback (control). The primary outcome was ventilation quality (rate and volume) at the final study session.

Results: The study ran from February to July 2025 and included 51 participants, mostly male (82%), with a median age of 39 years (IQR 33-45), who were primarily paramedics (92%). Participants completed 150 study sessions, generating 15.5 hours of ventilation data. There was a clear difference in ventilation quality (rate and volume) with VFD versus no VFD. The ventilation quality of the group that had feedback at only the first session declined sharply when feedback was removed, and by the third (final) study session this group was statistically no different from the control group. VFD use reduced instances of hyper- and hypoventilation.

Conclusion: This simulation-based, exploratory, randomised controlled trial demonstrated that VFD use improved the ability of ambulance clinicians to ventilate according to guidelines but when the VFD was removed, they rapidly reverted to a low level of compliance. Future work needs to study VFD use in clinical practice and to explore any impact on patient outcomes.