Prehospital Manual Ventilation: An NAEMSP Position Statement and Resource Document

Lyng, John; Guyette, Francis X.; Levy, Michael; Bosson, Nichole

doi:10.1080/10903127.2021.1981506

Cited by 9 publications

(5 citation statements)

References 89 publications

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“…Based on this result, more strength can be applied to the middle finger used for “C” shape and the finger maintaining the “E” shape. Maintaining the “E” shape when performing the E–C technique is essential for keeping the airway open during BVM bagging 1 , 5 , 10 , 20 . Thus, the pinch strength that affects the E–C technique during BVM bagging is the tripod pinch strength and applying a 200 g weight to the apex of the mask is considered to be a method for improving ventilation by increasing adhesion through the EC technique.…”

Section: Discussionmentioning

confidence: 99%

“…Positive-pressure ventilation can be implemented by manual methods, such as bag-valve-mask (BVM) bagging, and automatic methods, such as the use of ventilators. In emergency situations including those that arise during epidemics of respiratory infectious diseases, such as coronavirus disease 2019 (COVID-19), the rescuer’s first action is to provide positive-pressure ventilation using a BVM 1 – 3 . The rescuer places the mask around the patient’s nose and mouth with one hand for BVM bagging, closes the gap between the mask and the face using the E–C technique with their thumb and index finger, and opens the airway.…”

mentioning

confidence: 99%

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Effects of weights applied to the apex of a bag-valve-mask and pinch strength on tidal volume: a prospective simulation study

Uhm,

Kim,

Koh

et al. 2024

Sci Rep

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A bag-valve-mask (BVM) is a first aid tool that can easily and quickly provide positive-pressure ventilation in patients with breathing difficulties. The most important aspect of BVM bagging is how closely the mask adheres to the patient’s face when the E–C technique is used. In particular, the greater the adhesion force at the apex of the mask, the greater the tidal volume. The purpose of this study was to investigate the effect of various weights applied to the mask’s apex and the pinch strength needed to perform the E–C technique, on tidal volume. In this prospective simulation study, quasi-experimental and equivalent time-series designs were used. A total of 72 undergraduate paramedic student from three universities were recruited using convenience sampling. The tidal volumes according to the weights (0 g, 100 g, 200 g, 300 g) applied to the apical area of the mask, handgrip strength, and pinch strength (tip pinch strength, key pinch strength, and tripod pinch strength) were measured. A linear mixed model analysis was performed. Linear mixed model analyses showed that tidal volume was significantly higher at 200 g (B = 43.38, p = 0.022) and 300 g (B = 38.74, p = 0.017) than at 0 g. Tripod pinch strength (B = 12.88, p = 0.007) had a significant effect on mask adhesion for effective BVM ventilation. Adding weight to the apical area of the mask can help maintain the E–C technique and enable effective ventilation. Future studies are required to develop specific strategies to improve the ventilation skills, which can be an important first-aid activity.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effects of weights applied to the apex of a bag-valve-mask and pinch strength on tidal volume: a prospective simulation study

Uhm,

Kim,

Koh

et al. 2024

Sci Rep

View full text Add to dashboard Cite

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“…A recent statement paper from the National Association of EMS Physicians (NAEMSP) proposes that teaching the E-O grip over the E-C grip to novices is favorable. In the E-O grip, the operator encircles the mask neck with the first two digits of the hand and the other digits maintain the chin lift, providing a better seal of the mask to the face (20). Using a BMV expert-reviewed checklist during BMV skills teaching to medical students could be of valuable help (21).…”

Section: Discussionmentioning

confidence: 99%

“…If possible, the two-person technique should be favored over the one-person technique, both in adult and infant BMV, especially considering the great variability in oxygen delivery in BMV and the necessity to avoid gastric inflation (23)(24)(25). In medical students, the need to teach the two-person technique in BMV is therefore of great importance (20,(26)(27)(28)(29)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Bag-mask ventilation by low- or untrained rescuers during adult and pediatric resuscitation: a randomized cross-over manikin study

Borremans,

Geerts,

Coppens

et al. 2023

Front. Disaster Emerg. Med.

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AimBag-mask ventilation (BMV) is often applied during advanced cardiopulmonary resuscitation (CPR). Lay rescuers usually apply mouth-to-mouth ventilation, which is contraindicated in case of potential disease transmission (e.g., during the COVID-19 pandemic). This study evaluates the influence of rescuers' before BMV training in following the correct BMV procedures during adult and infant CPR.MethodsMedical students (n = 112) were enrolled in a randomized cross-over manikin study: 60 first-year students (53.6%) (untrained, without any prior knowledge of CPR) and 52 fourth-year students (46.4%) (BLS-trained, with three consecutive years of basic CPR training), excluding Basic Life Support (BLS) certificate holders or lifeguards. Student-formed duos (i.e., two students from the same year working together) received a 15-min just-in-time onsite training in full CPR cycle using BMV and were tested during five cycles of 2-person CPR following the European Resuscitation Council (ERC) guidelines with the inclusion of BMV. Tidal volumes of 300–600 ml (adults) and 20–60 ml (infants) were considered as correct ventilations.ResultsFrom the initial 56 duos, 17 (30.4%) were excluded after applying incorrect numbers of ventilation or uninterpretable values. In adult CPR, comparing BLS-trained rescuers to untrained ones in correctly administrating ventilations using BMV after a 15-min just-in-time onsite training revealed no statistically significant difference [first years: 63.0% (n = 136 out of 216 ventilations); fourth years: 59.5% (n = 119 out of 200 ventilations); with a proportional difference of −3.5% (−12.8; 5.9)]. In infant CPR, a significant difference was observed in effective ventilations [first years: 55.5% (n = 120 out of 216 ventilations); fourth years: 72.3% (n = 133 out of 184 ventilations); with a proportional difference of 16.8 (7.25; 26.21)].ConclusionTwo-person BMV is a complex skill to perform both in adults and children, requiring sufficient and regular training. Lay rescuers receiving a 15-min just-in-time onsite BMV training could perform decent BMV in an adult CPR setting. BMV during infant CPR requires more extensive prior training and should not be entrusted to lay rescuers, even after a 15-min just-in-time onsite training.

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“…Adequate ventilation through BVM remains a difficult skill to perform properly and must be practiced to maintain proficiency. [24][25][26] To maintain an open airway, the person performing ventilation must extend the neck and perform a jaw thrust maneuver or place an oral airway. In addition, a tight mask seal on the face must be maintained to prevent air from leaking around the mask, and the rescuer must then simultaneously squeeze the self-inflating bag for 1 to 1.5 s for each breath.…”

Section: Adequate Ventilation By Bvmmentioning

confidence: 99%

Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study

Idris,

Aramendi Ecenarro,

Leroux

et al. 2023

Circulation

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Background: Few studies have measured ventilation during early cardiopulmonary resuscitation (CPR) before advanced airway placement. Resuscitation guidelines recommend pauses after every 30 chest compressions to deliver ventilations. The effectiveness of bag-valve-mask ventilation delivered during the pause in chest compressions is unknown. We sought to determine: (1) the incidence of lung inflation with bag-valve-mask ventilation during 30:2 CPR; and (2) the association of ventilation with outcomes after out-of-hospital cardiac arrest. Methods: We studied patients with out-of-hospital cardiac arrest from 6 sites of the Resuscitation Outcomes Consortium CCC study (Trial of Continuous Compressions versus Standard CPR in Patients with Out-of-Hospital Cardiac Arrest). We analyzed patients assigned to the 30:2 CPR arm with ≥2 minutes of thoracic bioimpedance signal recorded with a cardiac defibrillator/monitor. Detectable ventilation waveforms were defined as having a bioimpedance amplitude ≥0.5 Ω (corresponding to ≥250 mL V T ) and a duration ≥1 s. We defined a chest compression pause as a 3- to 15-s break in chest compressions. We compared the incidence of ventilation and outcomes in 2 groups: patients with ventilation waveforms in <50% of pauses (group 1) versus those with waveforms in ≥50% of pauses (group 2). Results: Among 1976 patients, the mean age was 65 years; 66% were male. From the start of chest compressions until advanced airway placement, mean±SD duration of 30:2 CPR was 9.8±4.9 minutes. During this period, we identified 26861 pauses in chest compressions; 60% of patients had ventilation waveforms in <50% of pauses (group 1, n=1177), and 40% had waveforms in ≥50% of pauses (group 2, n=799). Group 1 had a median of 12 pauses and 2 ventilations per patient versus group 2, which had 12 pauses and 12 ventilations per patient. Group 2 had higher rates of prehospital return of spontaneous circulation (40.7% versus 25.2%; P <0.0001), survival to hospital discharge (13.5% versus 4.1%; P <0.0001), and survival with favorable neurological outcome (10.6% versus 2.4%; P <0.0001). These associations persisted after adjustment for confounders. Conclusions: In this study, lung inflation occurred infrequently with bag-valve-mask ventilation during 30:2 CPR. Lung inflation in ≥50% of pauses was associated with improved return of spontaneous circulation, survival, and survival with favorable neurological outcome.

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Prehospital Manual Ventilation: An NAEMSP Position Statement and Resource Document

Cited by 9 publications

References 89 publications

Effects of weights applied to the apex of a bag-valve-mask and pinch strength on tidal volume: a prospective simulation study

Effects of weights applied to the apex of a bag-valve-mask and pinch strength on tidal volume: a prospective simulation study

Bag-mask ventilation by low- or untrained rescuers during adult and pediatric resuscitation: a randomized cross-over manikin study

Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study

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