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Infant Ventilation and Oxygenation by Basic Life Support Providers: Comparison of Methods

Published online by Cambridge University Press:  28 June 2012

Thomas E. Terndrup  and
Daniel A. Warner
Thomas E. Terndrup*
Affiliation:
Departments of Emergency Medicine and Pediatrics, State University of New York Health Science Center at Syracuse, Syracuse, N.Y, USA
Daniel A. Warner
Affiliation:
College of Medicine, State University of New York Health Science Center at Syracuse, Syracuse, N.Y, USA
*
Department of Emergency Medicine, SUNY Health Science Center, 750 E. Adams St., Syracuse, NY 13210USA
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Abstract

Introduction:

Little information is available in the performance of infant ventilation by basic life support (BLS) personnel.

Hypothesis:

There are no significant differences between mouth-to-mouth (M-M), mouth-to-mask (M-Ma), pediatric bag-mask (PBM), and adult bag-mask (ABM) devices in the percent of acceptable breaths delivered by BLS providers.

Methods:

Fifty certified BLS providers performed five ventilation methods in random sequences for 60 seconds each on a 5kg infant mannequin following standardized instructions. Supplemental oxygen, 10 l/min, was supplied with one M-Ma trial and PBM methods. Airway patency, peak airway pressure (PAP), ventilatory rate (VR), tidal volume, and delivered oxygen concentration (FiO2) were recorded. The percent of breaths with excessive PAP (i.e., >30 mmHg), percent of acceptable breaths using loose (i.e., 25−125ml) and strict (i.e., 50−100ml) criteria, and FiO2 at at 15, 30, 45, and 60 seconds were compared between ventilation methods using ANOVA.

Results:

For all subjects and those with a patent airway (n=36), there were no significant differences in the percentage of acceptable breaths between the respective ventilation methods using loose or strict criteria. The proportion of excessive breaths produced by PBM (56±6) (mean±SEM; all subjects) and ABM (41±6.2) was significantly greater than M-Ma, with and without a patent airway. Although RR and the percentage of excessive breaths were not significantly different, the percentage of acceptable breaths and FiO2 delivered with each ventilation method was significantly better in the patent airway group.

Conclusion:

For BLS providers, M-Ma ventilation with supplemental O2 provided the best method of initial infant ventilation based upon the percent of acceptable breaths, oxygen delivery, and fewest excessive pressure breaths.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 1 , March 1992 , pp. 35 - 40
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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References

1. Smith, JP, Bodai, BI: The urban paramedic's scope of practice. JAMA 1985;253:544–548.CrossRefGoogle ScholarPubMed
2. Cummins, RO, Theis, W: Encouraging early defibrillation: The American Heart Association and automated external defibrillators. Ann Emerg Med 1990;19:1245–1248.Google Scholar
3. Aufderheide, TP, Hendley, GE, Thakur, et al. : The diagnostic impact of prehosptial 12-lead electrocardiography. Ann Emerg Med 1990;19:1280–1287.CrossRefGoogle Scholar
4. Braun, O, McCallion, R, Fazackerley, J: Characteristics of mid-sized urban EMS systems. Ann Emerg Med 1990;19:536–546.CrossRefGoogle Scholar
5. Holbrook, PR: Prehospital care of critically ill children. Cut Care Med 1980;8:537–540.CrossRefGoogle ScholarPubMed
6. Seidel, JS: Emergency medical services and the pediatric patient: Are the needs being met? II. Training and equipping emergency medical services providers for pediatric emergencies. Pediatrics 1986;78:808–812.CrossRefGoogle ScholarPubMed
7. Seidel, JS: A needs assessment of advanced life support and emergency medical services in the pediatric patient: State of the art. Circulation 1986;74(supplement IV):129–133.Google Scholar
8. Bushore, M: Emergency care of the child. Pediatrics 1987;79:572–576.Google Scholar
9. Selden, BS, Schnitzer, PG, Nolan, FX: Medicolegal documentation of prehospital triage. Ann Emerg Med 1990;19:547–551.Google Scholar
10. Swor, RA, Hoelzer, M: A computer-asisted quality assurance audit in a multiprovider EMS system. Ann Emerg Med 1990;19:286–290.CrossRefGoogle Scholar
11. Terndrup, TE, Kanter, RK, Cherry, RA: A comparison of infant ventilation methods performed by prehospital personnel. Ann Emerg Med 1989;18:607–611.Google Scholar
12. American Heart Association: Standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA 1986;255:2954–2969.Google Scholar
13. Elling, R, Politis, J: An evaluation of emergency medical technician's ability to use manual ventilation devices. Ann Emerg Med 1983;12:765–768.Google Scholar
14. Harrison, RR, Maull, KI, Keenan, RL et al. : Mouth-to-mask ventilation: A superior method of rescue breathing. Ann Emerg Med 1982;11:74–76.Google Scholar
15. Palme, C, Nystrom, B, Tunell, R: An evaluation of the efficacy of face masks in the resuscitation of new-born infants. Lancet 1985;1:207–210.Google Scholar
16. Stewart, RD, Kaplan, R, Pennock, B et al. : Influence of mask design on bag-mask ventilation. Ann Emerg Med 1985;14:403–406.CrossRefGoogle ScholarPubMed
17. Gioia, FR, Stephenson, RL, Alterwitz, SA: Principles of Respiratory Support and Mechanical Ventilation. In Rogers, MC, ed: Textbook of Pediatric Intensive Care. Baltimore, Md.: Williams & Wilkins, 1987. Vol. 1, pp. 113–169.Google Scholar
18. Gershan, WM, Jacobi, MS, Thach, BT: Maturation of cardiorespiratory interactions in spontaneous recovery from hypoxic apnea (autoresuscitation). Pediatr Res 1990;28:87–93.Google ScholarPubMed
19. Safar, P: Pocket Mask for emergency artificial ventilation and oxygen inhalation. Crit Care Med 1974;2:273–276.Google Scholar
20. Finer, NN, Barrington, KJ, Al-Fardley, F et al. : Limitations of self-inflating resuscitators. Pediatrics 1986;77:417–420.Google ScholarPubMed
21. Giffen, PR, Hope, CE: Preliminary evaluation of a prototype tube-valve-mask ventilator for emergency artificial ventilation. Ann Emerg Med 1991;20:262–266.Google Scholar
22. Thompson, JE, Bonner, B, Lower, GM: Pediatric cardiopulmonary arrests in rural populations. Pediatrics 1990;86:302–306.CrossRefGoogle ScholarPubMed