Efficacy of facemask ventilation techniques in novice providers - 18/05/13
: (Associate Professor), Michael Christopher Carey, MD a : (Assistant Professor), Darren Alan Braude, MD a, b : (Professor), Isaac Tawil, MD, FCCM a, b : (Assistant Professor), Timothy Randal Petersen, PhD a, c : (Research Coordinator, Adjunct Assistant Professor), Lev Deriy, MD a : (Assistant Professor), Mark Spencer Anderson, BA d : (Medical Student)Abstract |
Study Objective |
To determine which of two facemask grip techniques for two-person facemask ventilation was more effective in novice clinicians, the traditional E-C clamp (EC) grip or a thenar eminence (TE) technique.
Design |
Prospective, randomized, crossover comparison study.
Setting |
Operating room of a university hospital.
Subjects |
60 novice clinicians (medical and paramedic students).
Measurements |
Subjects were assigned to perform, in a random order, each of the two mask-grip techniques on consenting ASA physical status 1, 2, and 3 patients undergoing elective general anesthesia while the ventilator delivered a fixed 500 mL tidal volume (VT). In a crossover manner, subjects performed each facemask ventilation technique (EC and TE) for one minute (12 breaths/min). The primary outcome was the mean expired VT compared between techniques. As a secondary outcome, we examined mean peak inspiratory pressure (PIP).
Main Results |
The TE grip provided greater expired VT (379 mL vs 269 mL), with a mean difference of 110 mL (P < 0.0001; 95% CI: 65, 157). Using the EC grip first had an average VT improvement of 200 mL after crossover to the TE grip (95% CI: 134, 267). When the TE grip was used first, mean VTs were greater than for EC by 24 mL (95% CI: -25, 74). When considering only the first 12 breaths delivered (prior to crossover), the TE grip resulted in mean VTs of 339 mL vs 221 mL for the EC grip (P = 0.0128; 95% CI: 26, 209). There was no significant difference in PIP values using the two grips: the TE mean (SD) was 14.2 (7.0) cm H2O, and the EC mean (SD) was 13.5 (9.0) cm H2O (P = 0.49).
Conclusions |
The TE facemask ventilation grip results in improved ventilation over the EC grip in the hands of novice providers.
Le texte complet de cet article est disponible en PDF.Keywords : Airway, Airway management, Bag-valve mask ventilation, Basic life support, Facemask ventilation
Plan
| ☆ | Supported by departmental funding only. |
| ☆☆ | The authors have no conflicts of interest to declare. |
Vol 25 - N° 3
P. 193-197 - mai 2013 Retour au numéro
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