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Published in: BMC Emergency Medicine 1/2009

Open Access 01-12-2009 | Research article

Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation

Authors: Ziad Nehme, Malcolm J Boyle

Published in: BMC Emergency Medicine | Issue 1/2009

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Abstract

Background

Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort.

Methods

An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted.

Results

Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045).

Conclusion

Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.
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Literature
1.
go back to reference Aufderheide TP, Sigurdsson G, Pirrallo R, Yannopoulos D, McKnite S, Briesen C, Sparks C, Conrad C, Provo T, Lurie KG: Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004, 109: 1960-1965. 10.1161/01.CIR.0000126594.79136.61.CrossRefPubMed Aufderheide TP, Sigurdsson G, Pirrallo R, Yannopoulos D, McKnite S, Briesen C, Sparks C, Conrad C, Provo T, Lurie KG: Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004, 109: 1960-1965. 10.1161/01.CIR.0000126594.79136.61.CrossRefPubMed
2.
go back to reference Pepe PE, Raedler C, Lurie KG, Wigginton JG: Emergency ventilatory management in hemorrhagic states: elemental or detrimental?. J Trauma. 2003, 54 (6): 1048-1055. 10.1097/01.TA.0000064280.05372.7C.CrossRefPubMed Pepe PE, Raedler C, Lurie KG, Wigginton JG: Emergency ventilatory management in hemorrhagic states: elemental or detrimental?. J Trauma. 2003, 54 (6): 1048-1055. 10.1097/01.TA.0000064280.05372.7C.CrossRefPubMed
3.
go back to reference Davis DP, Dunford JV, Poste JC, Ochs M, Holbrook T, Fortlage D, Size MJ, Kennedy F, Hoyt DB: The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma. 2004, 57 (1): 1-10. 10.1097/01.TA.0000135503.71684.C8.CrossRefPubMed Davis DP, Dunford JV, Poste JC, Ochs M, Holbrook T, Fortlage D, Size MJ, Kennedy F, Hoyt DB: The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma. 2004, 57 (1): 1-10. 10.1097/01.TA.0000135503.71684.C8.CrossRefPubMed
4.
go back to reference International Liaison Committee on R: 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 2: Adult basic life support. Resuscitation. 2005, 67 (2–3): 187-201. International Liaison Committee on R: 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 2: Adult basic life support. Resuscitation. 2005, 67 (2–3): 187-201.
5.
go back to reference Terndrup TE, Cherry RA, McCabe JB: Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller. J Emerg Med. 1990, 8 (2): 121-125. 10.1016/0736-4679(90)90219-L.CrossRefPubMed Terndrup TE, Cherry RA, McCabe JB: Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller. J Emerg Med. 1990, 8 (2): 121-125. 10.1016/0736-4679(90)90219-L.CrossRefPubMed
6.
go back to reference Walsh K, Loveday K, O'Rathaille M: A comparison of the effectiveness of pre-hospital bag-valve-mask ventilation performed by Irish emergency medical technicians and anaesthetists working in a tertiary referral teaching hospital. Ir Med J. 2003, 96 (3): 77-79.PubMed Walsh K, Loveday K, O'Rathaille M: A comparison of the effectiveness of pre-hospital bag-valve-mask ventilation performed by Irish emergency medical technicians and anaesthetists working in a tertiary referral teaching hospital. Ir Med J. 2003, 96 (3): 77-79.PubMed
7.
go back to reference Thomas SH, Orf J, Wedel SK, Conn AK: Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice. J Trauma. 2002, 52 (1): 47-53. 10.1097/00005373-200201000-00010.CrossRefPubMed Thomas SH, Orf J, Wedel SK, Conn AK: Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice. J Trauma. 2002, 52 (1): 47-53. 10.1097/00005373-200201000-00010.CrossRefPubMed
8.
go back to reference Helm M, Hauke J, Lampl L: A prospective study of the quality of pre-hospital emergency ventilation in patients with severe head injury. Br J Anaesth. 2002, 88 (3): 345-349. 10.1093/bja/88.3.345.CrossRefPubMed Helm M, Hauke J, Lampl L: A prospective study of the quality of pre-hospital emergency ventilation in patients with severe head injury. Br J Anaesth. 2002, 88 (3): 345-349. 10.1093/bja/88.3.345.CrossRefPubMed
9.
go back to reference Augustine JA, Seidel DR, McCabe JB: Ventilation performance using a self-inflating anesthesia bag: effect of operator characterisitics. Am J Emerg Med. 1987, 5 (4): 267-270. 10.1016/0735-6757(87)90348-2.CrossRefPubMed Augustine JA, Seidel DR, McCabe JB: Ventilation performance using a self-inflating anesthesia bag: effect of operator characterisitics. Am J Emerg Med. 1987, 5 (4): 267-270. 10.1016/0735-6757(87)90348-2.CrossRefPubMed
10.
go back to reference Martin PD, Cyna AM, Hunter WA, Henry J, Ramayya GP: Training nursing staff in airway management for resuscitation. A clinical comparison of the facemask and laryngeal mask. Anaesthesia. 1993, 48 (1): 33-37.CrossRefPubMed Martin PD, Cyna AM, Hunter WA, Henry J, Ramayya GP: Training nursing staff in airway management for resuscitation. A clinical comparison of the facemask and laryngeal mask. Anaesthesia. 1993, 48 (1): 33-37.CrossRefPubMed
11.
go back to reference Helm M, Schuster R, Hauke J, Lampl L: Tight control of prehospital ventilation by capnography in major trauma victims. Br J Anaesth. 2003, 90 (3): 327-332. 10.1093/bja/aeg069.CrossRefPubMed Helm M, Schuster R, Hauke J, Lampl L: Tight control of prehospital ventilation by capnography in major trauma victims. Br J Anaesth. 2003, 90 (3): 327-332. 10.1093/bja/aeg069.CrossRefPubMed
12.
go back to reference Losert H, Sterz F, Kohler K, Sodeck G, Fleischhackl R, Eisenburger P, Kliegel A, Herkner H, Myklebust H, Nysaether J, et al: Quality of cardiopulmonary resuscitation among highly trained staff in an emergency department setting. Arch Intern Med. 2006, 166 (21): 2375-2380. 10.1001/archinte.166.21.2375.CrossRefPubMed Losert H, Sterz F, Kohler K, Sodeck G, Fleischhackl R, Eisenburger P, Kliegel A, Herkner H, Myklebust H, Nysaether J, et al: Quality of cardiopulmonary resuscitation among highly trained staff in an emergency department setting. Arch Intern Med. 2006, 166 (21): 2375-2380. 10.1001/archinte.166.21.2375.CrossRefPubMed
13.
go back to reference Pitts S, Kellermann AL: Hyperventilation during cardiac arrest. Lancet. 2004, 364 (9431): 313-315. 10.1016/S0140-6736(04)16740-8.CrossRefPubMed Pitts S, Kellermann AL: Hyperventilation during cardiac arrest. Lancet. 2004, 364 (9431): 313-315. 10.1016/S0140-6736(04)16740-8.CrossRefPubMed
14.
go back to reference Milander MM, Hiscok PS, Sanders AB, Kern KB, Berg RA, Ewy GA: Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance. Acad Emerg Med. 1995, 2 (8): 708-713. 10.1111/j.1553-2712.1995.tb03622.x.CrossRefPubMed Milander MM, Hiscok PS, Sanders AB, Kern KB, Berg RA, Ewy GA: Chest compression and ventilation rates during cardiopulmonary resuscitation: the effects of audible tone guidance. Acad Emerg Med. 1995, 2 (8): 708-713. 10.1111/j.1553-2712.1995.tb03622.x.CrossRefPubMed
15.
go back to reference O'Neill JF, Deakin CD: Do we hyperventilate cardiac arrest patients?. Resuscitation. 2007, 73 (1): 82-85. 10.1016/j.resuscitation.2006.09.012.CrossRefPubMed O'Neill JF, Deakin CD: Do we hyperventilate cardiac arrest patients?. Resuscitation. 2007, 73 (1): 82-85. 10.1016/j.resuscitation.2006.09.012.CrossRefPubMed
16.
go back to reference Doerges V, Sauer C, Ocker H, Wenzel V, Schmucker P: Smaller tidal volumes during cardiopulmonary resuscitation: comparison of adult and paediatric self-inflatable bags with three different ventilatory devices. Resuscitation. 1999, 43 (1): 31-37. 10.1016/S0300-9572(99)00117-3.CrossRefPubMed Doerges V, Sauer C, Ocker H, Wenzel V, Schmucker P: Smaller tidal volumes during cardiopulmonary resuscitation: comparison of adult and paediatric self-inflatable bags with three different ventilatory devices. Resuscitation. 1999, 43 (1): 31-37. 10.1016/S0300-9572(99)00117-3.CrossRefPubMed
17.
go back to reference Doerges V, Wenzel V, Neubert E, Schmucker P: Emergency airway management by intensive care unit nurses with the intubating laryngeal mask airway and the laryngeal tube. Crit Care. 2000, 4 (6): 369-376. 10.1186/cc720.CrossRef Doerges V, Wenzel V, Neubert E, Schmucker P: Emergency airway management by intensive care unit nurses with the intubating laryngeal mask airway and the laryngeal tube. Crit Care. 2000, 4 (6): 369-376. 10.1186/cc720.CrossRef
18.
go back to reference Hashimoto Y, Moriya F, Furumiya J: Forensic aspects of complications resulting from cardiopulmonary resuscitation. Leg Med. 2007, 9 (2): 94-99. 10.1016/j.legalmed.2006.11.008.CrossRef Hashimoto Y, Moriya F, Furumiya J: Forensic aspects of complications resulting from cardiopulmonary resuscitation. Leg Med. 2007, 9 (2): 94-99. 10.1016/j.legalmed.2006.11.008.CrossRef
19.
go back to reference Idris AH, Wenzel V, Becker LB, Banner MJ, Orban DJ: Does hypoxia or hypercarbia independently affect resuscitation from cardiac arrest?. Chest. 1995, 108 (2): 522-528. 10.1378/chest.108.2.522.CrossRefPubMed Idris AH, Wenzel V, Becker LB, Banner MJ, Orban DJ: Does hypoxia or hypercarbia independently affect resuscitation from cardiac arrest?. Chest. 1995, 108 (2): 522-528. 10.1378/chest.108.2.522.CrossRefPubMed
Metadata
Title
Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation
Authors
Ziad Nehme
Malcolm J Boyle
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2009
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/1471-227X-9-4

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