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Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial

Published online by Cambridge University Press:  15 August 2017

Paul Reed ,
Baruch Zobrist ,
Monica Casmaer ,
Steven G. Schauer ,
Nurani Kester  and
Michael D. April Open the ORCID record for Michael D. April [Opens in a new window]
Paul Reed
Affiliation:
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TexasUSA
Baruch Zobrist
Affiliation:
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TexasUSA
Monica Casmaer
Affiliation:
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TexasUSA
Steven G. Schauer
Affiliation:
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TexasUSA
Nurani Kester
Affiliation:
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TexasUSA
Michael D. April*
Affiliation:
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TexasUSA
*
Correspondence: Michael D. April, MD, DPhil, MSc 3551 Roger Brooke Dr. Fort Sam Houston, Texas 78216 USA E-mail: Michael.D.April@post.harvard.edu
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Abstract

Introduction

Ventilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting.

Hypothesis

Tidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model.

Methods

This study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark). Participants performed mask placement and delivery of 10 breaths per minute for three minutes, as guided by a metronome. After a three-minute rest period, they performed ventilation using the alternative device. The primary outcome measure was mean received tidal volume as measured by the manikin (IngMar RespiTrainer model; IngMar Medical; Pittsburgh, Pennsylvania USA). Secondary outcomes included subject device preference.

Results

Of 70 recruited participants, all completed the study. The difference in mean received tidal volume between ventilations performed using the modified BVM with external handle versus standard BVM was 20 ml (95% CI, -16 to 56 ml; P=.28). There were no significant differences in mean received tidal volume based on the order of study arm allocation. The proportion of participants preferring the modified BVM over the standard BVM was 47.1% (95% CI, 35.7 to 58.6%).

Conclusions

The modified BVM with added external handle did not result in greater mean received tidal volume compared to standard BVM during single rescuer ventilation in a manikin model.

ReedP, ZobristB, CasmaerM, SchauerSG, KesterN, AprilMD. Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial. Prehosp Disaster Med. 2017;32(6):625–630.

Keywords

apneamanikinmasksresuscitationventilation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 6 , December 2017 , pp. 625 - 630
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest/disclaimer: The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center (San Antonio, Texas USA), the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, the Department of Defense, or the US Government. The authors declare no conflicts of interest.

References

1. Kleinman, ME, Brennan, EE, Goldberger, ZD, et al. Part 5: adult Basic Life Support and cardiopulmonary resuscitation quality: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S414-S435.Google Scholar
2. Link, MS, Berkow, LC, Kudenchuk, PJ, et al. Part 7: adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S444-S464.CrossRefGoogle ScholarPubMed
3. Jeong, S, Ahn, KO, Shin, SD. The role of prehospital advanced airway management on outcomes for out-of-hospital cardiac arrest patients: a meta-analysis. Am J Emerg Med. 2016;34(11):2101-2106.Google Scholar
4. Komatsu, R, Kasuya, Y, Yogo, H, et al. Learning curves for bag-and-mask ventilation and orotracheal intubation: an application of the cumulative sum method. Anesthesiology. 2010;112(6):1525-1531.CrossRefGoogle ScholarPubMed
5. Davidovic, L, LaCovey, D, Pitetti, RD. Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children. Ann Emerg Med. 2005;46(1):37-42.CrossRefGoogle ScholarPubMed
6. Joffe, AM, Hetzel, S, Liew, EC. A two-handed jaw-thrust technique is superior to the one-handed “EC-clamp” technique for mask ventilation in the apneic unconscious person. Anesthesiology. 2010;113(4):873-879.CrossRefGoogle Scholar
7. Otten, D, Liao, MM, Wolken, R, et al. Comparison of bag-valve-mask hand-sealing techniques in a simulated model. Ann Emerg Med. 2014;63(1):6-12.CrossRefGoogle Scholar
8. Hart, D, Reardon, R, Ward, C, Miner, J. Face mask ventilation: a comparison of three techniques. J Emerg Med. 2013;44(5):1028-1033.CrossRefGoogle ScholarPubMed
9. Amack, AJ, Barber, GA, Ng, PC, Smith, TB, April, MD. Comparison of ventilation with one-handed mask seal with an intraoral mask versus conventional cuffed face mask in a cadaver model: a randomized crossover trial. Ann Emerg Med. 2017;69(1):12-17.Google Scholar
10. Lee, HY, Jeung, KW, Lee, BK, et al. The performances of standard and ResMed masks during bag-valve-mask ventilation. Prehosp Emerg Care. 2013;17(2):235-240.Google Scholar
11. Redfern, D, Rassam, S, Stacey, MR, Mecklenburgh, JS. Comparison of face masks in the bag-mask ventilation of a manikin. Eur J Anaesthesiol. 2006;23(2):169-172.Google Scholar
12. Stewart, RD, Kaplan, R, Pennock, B, Thompson, F. Influence of mask design on bag-mask ventilation. Ann Emerg Med. 1985;14(5):403-406.CrossRefGoogle ScholarPubMed
13. Wagner-Berger, HG, Wenzel, V, Stallinger, A, et al. Decreasing peak flow rate with a new bag-valve-mask device: effects on respiratory mechanics, and gas distribution in a bench model of an unprotected airway. Resuscitation.. 2003;57(2):193-199.CrossRefGoogle Scholar
14. Zobrist, B, Casmaer, M, April, MD. Single rescuer ventilation using a bag-valve mask with internal handle: a randomized crossover trial. Am J Emerg Med. 2016;34(10):1991-1996.CrossRefGoogle ScholarPubMed
15. Schulz, KF, Altman, DG, Moher, D, Group, C. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. PLoS Med. 2010;7(3):e1000251.CrossRefGoogle Scholar
16. Menegazzi, JJ, Winslow, HJ. In-vitro comparison of bag-valve-mask and the manually triggered oxygen-powered breathing device. Acad Emerg Med. 1994;1(1):29-33.Google Scholar
17. Updike, G, Mosesso, VN Jr., Auble, TE, Delgado, E. Comparison of bag-valve-mask, manually triggered ventilator, and automated ventilator devices used while ventilating a non-intubated manikin model. Prehosp Emerg Care. 1998;2(1):52-55.Google Scholar
18. von Goedecke, A, Wagner-Berger, HG, Stadlbauer, KH, et al. Effects of decreasing peak flow rate on stomach inflation during bag-valve-mask ventilation. Resuscitation. 2004;63(2):131-136.Google Scholar
19. Zecha-Stallinger, A, Wenzel, V, Wagner-Berger, HG, von Goedecke, A, Lindner, KH, Hormann, C. A strategy to optimize the performance of the mouth-to-bag resuscitator using small tidal volumes: effects on lung and gastric ventilation in a bench model of an unprotected airway. Resuscitation. 2004;61(1):69-74.CrossRefGoogle Scholar
20. April, MD, Murray, BP. Cost-effectiveness analysis appraisal and application: an emergency medicine perspective. Acad Emerg Med. 2017;24(6):754-768.Google Scholar