Oxygenation During CPR: Is Continuous Flow Oxygen Better Than BVM?
Oxygenation and ventilation remain relatively under-studied components of cardiac resuscitation.
Continuous flow oxygen insufflation (CFIO) is an attractive concept: deliver continuous oxygen while minimising interruptions to chest compressions. But does it improve outcomes compared with conventional bag-valve-mask (BVM) ventilation?
The Study
Segond N, et al. Neurological outcome of out-of-hospital cardiac arrest patients ventilated with continuous flow insufflation of oxygen: a multicenter observational study. Resuscitation. 2026;225:111113.
This multicentre observational study compared BVM ventilation with CFIO using the Boussignac B-Card in 2,237 patients with out-of-hospital cardiac arrest.
What Did They Find?
There was no significant difference in ROSC.
However, compared with BVM, CFIO was associated with:
- Lower survival to hospital admission
- Lower 30-day survival
- Worse favourable neurological survival at 30 days — adjusted OR 0.61 (95% CI 0.41–0.90)
Interestingly, when one French region changed from BVM to CFIO, survival also fell, while survival in neighbouring regions continuing to use BVM remained relatively stable.
The Bottom Line
Continuous oxygen insufflation sounds attractive: uninterrupted compressions with continuous oxygen delivery.
But oxygenation is only part of the equation. Ventilation matters too.
This study doesn’t support replacing conventional BVM ventilation with CFIO during cardiac arrest.
Want the Deep Dive?
Why might CFIO result in worse outcomes? What are the limitations of this study, and could CO₂, intrathoracic pressure, venous return and cerebral haemodynamics help explain the findings?
