Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-23T01:47:27.695Z Has data issue: false hasContentIssue false
  • English
  • Français

Airway management by first responders when using a bag-valve device and two oxygen-driven resuscitators in 104 patients

Published online by Cambridge University Press:  23 December 2004

G. J. Noordergraaf ,
P. J. van Dun ,
B. P. Kramer ,
M. P. Schors ,
H. P. Hornman ,
W. de Jong  and
A. Noordergraaf
G. J. Noordergraaf
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
P. J. van Dun
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
B. P. Kramer
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
M. P. Schors
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
H. P. Hornman
Affiliation:
Fire Department, City of Tilburg, Tilburg, The Netherlands
W. de Jong
Affiliation:
St. Elisabeth Hospital, Department of Clinical Physics, EN Tilburg, The Netherlands
A. Noordergraaf
Affiliation:
University of Pennsylvania, Departments of Bioengineering and Anaesthesiology, PA, USA
Get access

Abstract

Summary

Background and objective: To evaluate the capability of first responders to ensure an airway and ventilate the lungs of a patient employing a bag-valve device and two oxygen-driven resuscitators.

Methods: Prospective, controlled, blinded, single-centre clinical trial using a bag-valve device and one of two FR-300® devices, with 20 cmH2O working pressure, flows of 24 and 30 L min−1. One-hundred-and-four patients were analysed. Induction of anaesthesia was followed by ventilation of the lungs with a bag-valve device and an Oxylator® (CPR Medical Devices Corp., Markham, Ontario, Canada) in manual and automatic modes. Each series was repeated twice by a fireman first responder using a hand-held mask to seal the airway, once under anaesthesia and then again under anaesthesia with muscle relaxation.

Results: Patients’ mean age 49 ± 17 yr; 47% male, 48–132 kg. Only 29% had optimal facial and airway physiognomy. Airway management was significantly poorer when the bag-valve device was used than with either Oxylator® mode (P < 0.0001); 23% of cases were not manageable with the bag-valve device. Gastric insufflation was markedly less with the Oxylator® (P < 0.02).

Conclusions: The use of an oxygen-driven device improves the ability of first responders to secure an airway and reduce gastric insufflation, even when distracted. Oxylators® perform significantly better (P < 0.0001) than the bag-valve device.

Keywords

EQUIPMENT AND SUPPLIES, ventilators, mechanicalEMERGENCY TREATMENT, respiration artificial, first aidHEALTHCARE QUALITY ASSESSMENT AND EVALUATION, technology assessment, biomedical
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 5 , May 2004 , pp. 361 - 366
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Braman SS, Dunn SM, Amico CA, Millman RP. Complications of intrahospital transport in critically ill patients. Ann Internal Med 1987; 107: 469–473.Google Scholar
Cummins RO, Austin D, Graves JR, Litwin PE, Pierce J. Ventilation skills of emergency medical technicians: a teaching challenge for emergency medicine. Ann Emerg Med 1986; 15: 1187–1192.Google Scholar
Wayne MA, Delbridge TR, Ornato JP, Swor RA, Blackwell T. Concepts and application of prehospital ventilation. Prehosp Emerg Care 2001; 5: 73–78.Google Scholar
Law GD. Effects of hand size on Ve, Vt and FiO2 during manual resuscitation. Resp Care 1982; 27: 1236–1238.Google Scholar
Augustine JA, Seidel DR, McGabe JB. Ventilation performance using a self-inflating anesthesia bag: effect of operator characteristics. Am J Emerg Med 1987; 5: 267–270.Google Scholar
Ruben H, Knudsen EJ, Carugati G. Gastric inflation in relationship to airway pressure. Acta Anaesth Scand 1961; 5: 107–114.Google Scholar
Weiler HW, Heinrichs W, Dick W. Assessment of pulmonary mechanics and gastric inflation pressure during mask ventilation. Prehosp Disaster Med 1995: 10: 101–105.Google Scholar
Ho-Tai LM, Devitt JH, Noel AG, O'Donnell MP. Gas leak and gastric insufflation during controlled ventilation: face mask versus laryngeal mask airway. Can J Anesth 1998; 45: 206–211.Google Scholar
Wenzel V, Idris AH, Banner MJ, et al. Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure. Resuscitation 1998; 38: 113–118.Google Scholar
Wenzel V, Idris AH, Banner MJ, Kubilis PS, Williams JrJL. Influence of tidal volume on the distribution of gas between the lungs and the stomach in the nonintubated patient receiving positive-pressure ventilation. Crit Care Med 1998; 26: 364–368.Google Scholar
Updike G, Mosesso VN, Auble TE, Delgado E. Comparison of bag-valve-mask, manually triggered ventilator, and automated ventilator devices used while ventilating a nonintubated manikin model. Prehosp Emerg Care 1998; 2: 52–55.Google Scholar
Johannigman JA, Branson RD, Davis K, Hurst JM. Techniques of emergency ventilation: a model to evaluate tidal volume, airway pressure and gastric insufflation. J Trauma 1991; 31: 93–98.Google Scholar
Hess D, Goff G. The effect of two-hand versus one-hand ventilation on volumes delivered during bag-valve ventilation at various resistances and compliances. Resp Care 1987; 32: 1025–1028.Google Scholar
Fuerst RS, Melker RJ. Gastric inflation in the unintubated patient: a comparison of common ventilating devices. Ann Emerg Med 1992; 21: 219.Google Scholar
Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC). JAMA 1980; 244: 453–509.
Osterwalder JJ, Schuhwerk W. Effectiveness of mask ventilation in a training mannikin. A comparison between the oxylator EM100 and the bag-valve device. Resuscitation 1998; 36: 23–27.Google Scholar
van Dun PJM, Schors MPHJ, Gyssens JMJ, Noordergraaf GJ. The effect of the Oxylator in patients under anesthesia: end tidal CO2 and airway management. Resuscitation 2000; 45: S18.Google Scholar
Mens M, Zandstra DF. Impact of a mask attached automatic mini-ventilator (Oxylator) in skillslab CPR setting on mask-ventilation performance. Resuscitation 2000; 45: S39.Google Scholar
Menegazzi JJ, Winslow HJ. In-vitro comparison of bag-valve-mask and the manually triggered oxygen powered breathing device. Acad Emerg Med 1994; 1: 29–33.Google Scholar