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Cardiac arrest
Smaller bags worse for CPR ventilation
Bag size for manual ventilation during cardiopulmonary resuscitation in adult cardiac arrest: a systematic review
Resuscitation Plus · Added 9 August 2026
Systematic review testing whether smaller self-inflating bags improve CPR outcomes — they found limited very-low-certainty evidence suggesting smaller bags (450-700mL) were associated with lower survival with favourable neuro outcomes compared to standard adult bags (1000-1685mL).
- Study type
- Systematic review
- Design
- Systematic review (ILCOR Continuous Evidence Evaluation, GRADE)
- Participants
- One observational study of 1994 OHCA patients plus two simulation cross-over studies
- Main finding
- Smaller bags (450–700 mL) were associated with lower survival with favourable neurological outcome (AOR 0.65, 95% CI 0.43–0.99) and lower event survival (AOR 0.73, 95% CI 0.60–0.90) versus standard adult bags (1000–1685 mL); no randomised trials identified
- Caveat
- Very-low certainty evidence from a single before-and-after observational study and no randomised trials
- Bottom line
- Supports current practice
Why it matters in Australia (High relevance). Directly relevant to prehospital CPR practice — bag valve choice is a standard clinical decision and these findings challenge the assumption that smaller bags are safer for airway protection during CPR.
Learning goal
Update my choice of self-inflating bag size when ventilating adults in cardiac arrest.
More
- Topic: Cardiac arrest
- Daily scan: 9 August 2026
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