To intubate or not: ventilation is the question. A manikin-based observational study

Abstract

IntroductionThere is a continuous debate concerning the superiority of endotracheal intubation on bag-valve-mask (BVM) ventilation in patients with cardiac arrest. In this manikin-based observational study, we evaluate and compare the performance of manual ventilation through a facemask (BVM) and an endotracheal tube (ETT).MethodsOne hundred and forty healthcare providers were instructed to manually ventilate a manikin as they would do for a 75 kg adult patient in respiratory arrest. Each one was ventilating both through a facemask and an ETT for a 5 min period in a random order. Ventilatory parameters were measured by the ASL 5000 lung simulator and ventilation performance was analysed using a sliding window method published in a previous study to assess accurately ventilation efficiency.ResultsThe mean ventilation rate was high whatever the technique used (24 bpm). A weak relationship between manual ventilation performance and the type of interface used was observed (p=0.0484). The overall rate of adequate ventilation was low even if we noticed a slight improvement when ventilating through an ETT (13.21% vs 7.5% of adequate ventilation). However, the rate of hyperventilation did not differ between mask and tube (79% vs 77%). A significant relationship is observed between professional category, the size of the hand squeezing the bag and manual ventilation performance (p<0.05).ConclusionWhatever the interface used, healthcare professionals are still struggling to perform manual ventilation efficiently according to international guidelines. Ventilation with an ETT does not prove to be significantly more efficient than with a facemask. It would be therefore important to recentre the debate on controlling ventilatory parameters with current devices. Focusing on training may maximise manual ventilation efficiency and minimise the loss of time during cardiopulmonary resuscitation.

Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study

“…However, this study was designed only to evaluate ventilation techniques and no compression was used in their simulation scenarios. 15 The current study findings reveal that the ventilation rate of asynchronous ventilation with BVM was also slower than that with LMA, and the ventilation rate with BVM was closer to the recommended rate.…”

Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial

“…Adherence to CPR algorithms is not always optimal and may vary between different components of the algorithm [ 21 , 22 , 23 , 24 , 25 ]. Although poor adherence to recommendations concerning airway management [ 26 ] may significantly contribute to the contradictory and inconclusive data on optimal ventilation during CPR, there are only limited data available. Airway management and its shortcomings are difficult to capture in real cases and especially so in the early phase of arrests as providing functional recording equipment or trained observers prior to the start of resuscitation efforts poses significant practical and ethical constraints.…”

Ventilation During Cardiopulmonary Resuscitation: What Have We Learned From Models?

“…1,2 Regarding the optimum treatment of cardiac arrest, the application of ventilation during CPR remains a field of uncertainty, 3 with a substantial lack of robust ev- idence and conclusive recommendations. [4][5][6][7] Indeed, most of the studies on ventilation during CPR have focused on its interaction with the efficacy of chest compressions and hemodynamic consequences. 8 Very little is known about the physiological effects of ventilation delivery during CPR, meaning that a comprehensive understanding of its role is still lacking.…”