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Impact of A Pressure-Responsive Flow-Limiting Valve on Bag–valve–mask Ventilation in an Airway Model

Published online by Cambridge University Press:  21 May 2015

Jonnathan M. Busko  and
Thomas H. Blackwell
Jonnathan M. Busko*
Affiliation:
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
Thomas H. Blackwell
Affiliation:
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
*
Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Blvd., Charlotte NC 28203; [email protected]

Abstract

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Objective:

Using a simulated airway model, we compared ventilation performance by emergency medical services (EMS) providers using a traditional bag–valve–mask (Easy Grip®) resuscitator to their performance when using a new device, the SMART BAG® resuscitator, which has a pressure-responsive flow-limiting valve.

Methods:

We recruited EMS providers at an EMS educational forum and performed a randomized, non-blinded, prospective crossover comparison of ventilation with 2 devices on a non-intubated simulated airway model. Subjects were instructed to ventilate a Mini Ventilation Training Analyzer® as they would an 85-kg adult patient in respiratory arrest. After being randomized to order of device use, they performed ventilation for 1 minute with each device. Primary outcomes were ventilation rates and peak airway pressures. We also measured average tidal volume, gastric inflation volume, minute ventilation and inspiratory:expiratory (I:E) ratio, and compared our results to the American Heart Association standards (2005 edition).

Results:

We observed statistically significant differences between the SMART BAG® and the traditional bag–valve–mask for respiratory rate (12 v. 14 breaths/min), peak airway pressure (15.6 v. 18.9 cm H2O), gastric inflation (239.6 v. 1598.4 mL), minute ventilation (7980 v. 8775 mL), and I:E ratio (1.3 v. 1.1). Average tidal volume was similar with both devices (679.6 v. 672.2 mL).

Conclusion:

The SMART BAG® provided ventilation performance that was more consistent with American Heart Association guidelines and delivered similar tidal volumes when compared with ventilation with a traditional bag–valve–mask resuscitator.

Keywords

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Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 3 , May 2006 , pp. 158 - 163
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

References

1.Elling, R, Politis, J. An evaluation of emergency medical technician's ability to use manual ventilation devices. Ann Emerg Med 1983;12:765–8.CrossRefGoogle ScholarPubMed
2.Martin, PD, Cyna, AM, Hunter, WA, et al. Training nursing staff in airway management for resuscitation. A clinical comparison of the facemask and laryngeal mask. Anaesthesia 1993;48:133–7.CrossRefGoogle ScholarPubMed
3.Wynne, G, Marteau, TM, Johnston, M, et al. Inability of trained nurses to perform basic life support. Br Med J (Clin Res Ed) 1987;294:1198–9.Google Scholar
4.Lurie, KG, Zielinski, T, McKnite, S, et al. Use of an inspiratory impedance valve improves neurologically intact survival in a porcine model of ventricular fibrillation. Circulation 2002; 105:124–9.Google Scholar
5.Aufderheide, T, Sigurdsson, G, Pirrallo, RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 2004;109:1960–5.CrossRefGoogle ScholarPubMed
6.Bowman, FP, Menagazzi, JJ, Check, BD, et al. Lower esophageal sphincter pressure during prolonged cardiac arrest and resuscitation. Ann Emerg Med 1995;26:216–9.CrossRefGoogle ScholarPubMed
7.Ornato, JP, Bryson, BL, Donovan, PJ, et al. Measurement of ventilation during cardiopulmonary resuscitation. Crit Care Med 1983;11:79–82.CrossRefGoogle ScholarPubMed
8.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;57:193–9.CrossRefGoogle Scholar
9.Milander, MM, Hiscok, PS, Sanders, AB, et al. Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance. Acad Emerg Med 1995;2:708–13.CrossRefGoogle ScholarPubMed
10.Busko, J, Dailey, M, Goodwin, F. Comparison of ventilatory efficacy of the standard bag-valve-mask and the SMART BAG® [abstract]. Prehospital Emerg Care 2004;8:88.CrossRefGoogle Scholar
11.Wagner-Berger, HG, Wenzel, V, Voelckel, WG, et al. A pilot study to evaluate the SMART BAG®: a new pressure-responsive, gas-flow limiting bag-valve-mask device. Anesth Analg 2003;97:1686–9.CrossRefGoogle Scholar
12.2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 7.1: Adjuncts for airway control and ventilation. Circulation 2005;112(suppl I):IV–51–7. Available: http://circ.ahajournals.org/content/vol112/24_suppl/ (accessed 2006 Mar 22).Google Scholar
13.Wenzel, V, Idris, AH, Banner, MJ, et al. Influence of tidal volume on the distribution of gas between the lungs and stomach in the nonintubated patient receiving positive-pressure ventilation. Crit Care Med 1998;26:364–8.Google Scholar
14.Wenzel, V, Idris, AH, Dorges, V, et al. The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for the patient with an unprotected airway. Resuscitation 2001;49:123–34.Google Scholar