New device designed to provide
continuous oxygen delivery during CPR
By W. Scott Gilmore, MD, EMT-P, FACEP, FAEMS
“No pause should be your cause,” or so French medical device manufacturer Vygon believes.
In March, JEMS Editor-in-Chief A.J.
Heightman and I traveled to Paris to attend
a one-day emergency symposium titled,
Alveolar Ventilation by Continuous
Chest Compression: b-card, a new
device designed for use during cardiac arrest management.
During the symposium, current
cardiac arrest guidelines, the Boussignac Cardiac Arrest Resuscitation Device
(b-card) and how the two are interconnected
The b-card is available and in use in Europe
and Canada; however, it’s not available or
approved for sale in the United States. Vygon
has applied to the Food and Drug Administration (FDA) for approval for use in the U.S.
The resuscitation symposium started with
a review of the current International Liaison
Council on Resuscitation (ILCOR) guidelines
on cardiac arrest and a comparison of the guidelines put forth by the American Heart Association and the European Resuscitation Council.
It was emphasized during the first half of
the symposium, and acknowledged by resuscitation experts present from multiple countries, that early citizen response and initiation
of CPR along with high quality, consistent
CPR by emergency crews are paramount to
This was discussed and supported by obser-vational studies which have shown that, in
general, the quality of CPR is poor during
out-of-hospital cardiac arrest. Additionally,
multiple studies show that interruptions in
chest compressions not only decrease coronary perfusion pressure1 but are also associated with decreased defibrillation success and
poor outcome. 2–5
Resuscitations are often hampered in Paris
by the lack of early citizen response and performance of CPR prior to EMS crew arrival. This
major factor has kept Paris’ ROSC level below
10%, despite an outstanding response system
in place that utilizes physician-staffed
ALS units operated by Service d’Aide
Médicale Urgente (SAMU, translated from French as Urgent Medical
Aid Service) and the predominantly
BLS Paris Fire Brigade.
On the other end of the resuscitation
spectrum, patients in Paris who remain in v fib
and who receive extracorporeal membrane oxygenation (ECMO) bypass treatment in the field
by a specialized SAMU response team are successfully resuscitated more than 30% of the time.
Paris’ medical leadership is working on ways
to get citizens to perform early CPR by using
software to alert citizens of the location of
AEDs. If Paris ramps up its citizen involvement, it’s clear that their overall resuscitation
rate could skyrocket.
Although advanced airway devices allow for
continuous chest compressions, prolonged
interruptions associated with advanced airway
placement may negate this benefit. One study
observed that CPR was interrupted for 46. 5
seconds (interquartile range [IQR] 23. 5 to
73 seconds) on the first attempt at intubation
and total interruptions to chest compressions
due to endotracheal intubation lasted 109.5
seconds (IQR 54 to 198 seconds). 6
Authors of this study also pointed out that
total endotracheal intubation–associated CPR
interruption time accounted for approximately
one fourth of the total CPR interruptions
The b-card creates a virtual valve that ensures dynamic alveolar ventilation without the need to interrupt