Real-time ventilation feedback devices for out-of-hospital cardiac arrest: a review of the literature.

Introduction: In the United Kingdom, ambulance services attempt resuscitation on 30,000 people per year, with fewer than 9% surviving and leaving hospital. Correct ventilation during out-of-hospital cardiac arrest (OHCA) is essential, as both hypo- and hyperventilation are linked to increased mortality. Despite this, ventilations are frequently given outside of recommended guidelines. Devices providing real-time feedback on ventilations aim to improve performance. While systematic reviews show that real-time feedback devices improve chest compression performance, evidence regarding ventilation feedback devices (VFDs) has not yet been synthesised. This literature review aimed to synthesise evidence on the effects of VFDs in OHCAs. Methods: Databases searched in March 2025 included MEDLINE, CINAHL and Embase. Inclusion criteria were papers published after 1 January 2018, in English, involving adults, focused on clinical practice or simulated OHCA and employing primary research with interventional study designs. The intervention criteria required a VFD that measured and provided feedback on both tidal volume and ventilation rate. Study quality was assessed using the Critical Appraisal Skills Programme checklist. Methods for synthesis included a narrative summary of findings. Results: The searches yielded 793 results. Nine studies met the inclusion criteria: seven simulation studies and two real-world studies. Simulation studies confirmed that ambulance clinicians often did not meet advanced life support guidelines for ventilations. Introducing VFDs significantly improved compliance, accuracy and precision of delivered ventilations in simulated OHCA scenarios. Real-world studies found an increase in ventilation compliance; however, the study examining patient outcomes was of low quality and did not find a statistically significant effect. Conclusion: The evidence suggests that VFDs are beneficial in simulated OHCA. Real-world studies suggest that the increase in ventilation performance may not be as significant as shown in simulation studies, and their effect on clinical outcomes has not yet been adequately explored.