Advancing ventilation during cardiopulmonary resuscitation: a question of optimizing quality, ventilation parameters or both?

PURPOSE OF REVIEW: Ventilation is provided to most patients during cardiopulmonary resuscitation (CPR). International guidelines emphasize the need for effective intra-arrest ventilation while acknowledging uncertainty regarding the optimal ventilation parameters. This review will discuss how new studies challenge prior beliefs on key ventilation parameters, will highlight challenges and potential solutions for high-quality ventilation and will suggest a translational research approach to advance intra-arrest ventilation. RECENT FINDINGS: A recent observational study reported that higher ventilation rates during in-hospital cardiac arrest may be positively associated with return of spontaneous circulation, challenging common beliefs. Additionally, a pivotal observational study on bag-valve-mask ventilation during out-of-hospital cardiac arrest found that ventilation was frequently ineffective and if so, associated with reduced survival and neurological function. Scoping and systematic reviews on intra-arrest ventilation parameters, ventilation feedback devices and mechanical ventilation have uncovered uncertainties regarding fundamental aspects of intra-arrest ventilation. SUMMARY: This review contextualizes the scientific debate on how to optimize intra-arrest ventilation by healthcare professionals. It covers emerging evidence on bag-valve-mask ventilation quality along with controversies around the optimal intra-arrest ventilation parameters, ventilation feedback devices and mechanical ventilation during CPR. Finally, implications for clinical practice are provided, and a translational approach is proposed to advance intra-arrest ventilation.