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2 Minute EBP Challenge

Monday, January 30, 2012
Scrub the Hub
The Centers for Disease Control (CDC) recommends that central venous catheter (CVC) hubs be scrubbed for how long?

Monday, January 23, 2012
Severe Sepsis and AF Risk
Up to 20% of patients with severe sepsis develop a new onset atrial fibrillation.  Which factor was not associated with increased risk?

Monday, January 16, 2012
Unreported Hospital Errors
In a recent study the Department of Health and Human Service reports that what percentage of hospital errors go unreported?

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  • Get tips, timesavers, and more from
    David W. Woodruff, MSN, RN-BC, CNS, CMSRN, CEN

    Home > 2 Minute EBP Challenge > Better outcomes in VT/VF

    Better outcomes in VT/VF

    Monday, December 28, 2009

    Stay up-to-date the easy way!

    How would you answer this question?

    Recent studies have demonstrated that passive ventilation with a non-rebreather mask results in better outcomes than active ventilation with a bag-valve mask in which type of cardiac arrest?

    a. In-hospital asystole
    b. Post-surgical pulseless electrical activity (PEA)
    c. Traumatic ventricular tachycardia
    d. Out-of-hospital ventricular fibrillation

    The correct answer is "d" out-of-hospital ventricular fibrillation

    Traditionally, cardiopulmonary resuscitation (CPR) has involved the use of chest compressions and positive-pressure assisted ventilation by bag-valve mask or mouth-to-mouth breathing.  The focus of CPR has been on improving oxygenation by increasing the rate or depth of ventilations.  The problem with this approach is that increasing ventilation increases intrathoracic pressure.

    Chest compressions squeeze the heart between the sternum and spine and force blood out of the ventricle causing cardiac output.  Releasing the chest causes elastic recoil of the chest and heart allowing the heart to fill again.  The "vacuum" caused by the release of the chest encourages venous return to the heart and increases cardiac output.

    Recent research demonstrates that ventilation increases intrathoracic pressure and decreases venous return to the heart which decreases cardiac output.  So, the more that nurses ventilate during CPR, the lower the cardiac output and worse the outcomes. 

    In a study reported by Bobrow, et al. the authors found that passive ventilation administered with a non-rebreather oxygen mask and no forced ventilation led to better neurological outcomes than oxygenation with a bag-valve mask.

    The take home point is that the more you ventilate the patient in cardiac arrest, the lower the cardiac ouptput will be and the worse the outcomes will become -- ventilate less, and focus on chest compressions!

    From: Bobrow, B.J., et al. (2009).  Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed out-of-hospital cardiac arrest.  Ann Emerg. Med. 54:656.

    Congratulations to Jackie Barrett who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Jackie!   

    Best wishes,
    David W. Woodruff, MSN, RN-BC, CNS, CEN
    President,     Ed4Nurses, Inc.

    PS. Achieve more in 2010 than ever before!  Find out how a professional coach can help.

    (c) 2009 Ed4Nurses, Inc.  Feel free to print this e-mail and share it with your colleagues. Other forms of digital or print reproduction are prohibited without prior written consent from Ed4Nurses, Inc.
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