CAAM: Is Bag-Mask Ventilation Superior to ETI During CPR?

While observational studies have suggested that bag-mask ventilation (BMV) during CPR is associated with a better survival rate than endotracheal intubation (ETI), findings from the CAAM study presented during ESC Congress 2017 in Barcelona were inconclusive and did not demonstrate BMV superiority. However, researchers did find increased complications and difficulty with BMV compared with ETI.

The study randomized 2,043 patients with out-of-hospital cardiac arrest from 15 centers in France and five in Belgium to receive either BMV or ETI during CPR. The primary endpoint was survival with good neurological function at 28 days.

Results showed the same rate of survival with good neurological outcomes across both the BMV and ETI groups (4.2 percent vs. 4.3 percent, respectively). However, the BMV technique failed in 6.7 percent of patients (compared with 2.1 percent with ETI) and there was a much greater incidence of regurgitation/aspiration with BMV (15.2 percent) compared with ETI (7.5 percent).

“Mask ventilation did not appear to be without danger in our trial,” said Frederic Adnet, MD, an emergency physician at Avicenne Hospital in Bobigny, France, and principal investigator of the CAAM study. “We were surprised by the much higher incidence of failure of the BMV technique compared with ETI. The higher incidence of regurgitation/aspiration in the BMV group confirms previous studies linking BMV with risks for the patient.” 


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