Quality of bag-valve-mask ventilation in adults: a comparison of paramedic and nurse performance
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Abstract
INTRODUCTION: Oxygen delivery is an essential skill required for healthcare providers. The quality of ventilation affects patient survival. The purpose of this study was to analyze the quality of manual ventilation delivered with a bag-valve-mask (BVM) device by paramedics and nurses in relation to their clinical experience and self-assessment. MATERIAL AND METHODS: A prospective experimental comparative simulation study was designed. Two hundred healthcare workers were invited (100 paramedics and 100 nurses) to manage an adult respiratory arrest scenario and perform a 4-minute manual ventilation cycle. Ventilation parameters were assessed with SimMan 3G human patient simulator. Data on demographics, occupation, clinical experience, and self-assessment of conducted ventilation were collected through a questionnaire. RESULTS: Statistically significant differences in gender distribution across professions (p < 0.001), relationship between experience and occupation (p = 0.018), and frequency of ventilation within a year (p < 0.001) were observed. The median value for self-assessment in skills was 3 for nurses and 4 for paramedics. The average tidal volume in nurses was 394.6 mL and 390.1 mL in the paramedics group (p = 0.674). The mean ventilation rate was 10.4 bpm and 8.9 bpm respectively (p = 0.013). Only 4% of nurses and 1% of paramedics met the European Resuscitation Council (ERC) 2021 guidelines for manual ventilation. A statistically significant correlation was found between ventilation parameters and professional experience. More experienced providers tended to ventilate faster (R = 0.158, p = 0.025) and with a higher volume (R = 0.265, p < 0.001). CONCLUSIONS: Despite ventilations being performed by experienced personnel, ERC guidelines were met incidentally. It is recommended to pay more attention to BVM ventilation training even among experienced staff.
Keywords: bag-valve maskmanual ventilationBVMperformanceefficiency
References
- Soar J, Nolan JP. Airway management in cardiopulmonary resuscitation. Curr Opin Crit Care. 2013; 19(3): 181–187.
- von Goedecke A, Herff H, Paal P, et al. Field airway management disasters. Anesth Analg. 2007; 104(3): 481–483.
- Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004; 32(9 Suppl): S345–S351.
- Komatsu R, Kasuya Y, Yogo H, et al. Learning curves for bag-and-mask ventilation and orotracheal intubation: an application of the cumulative sum method. Anesthesiology. 2010; 112(6): 1525–1531.
- Carlson JN, Wang HE. Updates in emergency airway management. Curr Opin Crit Care. 2018; 24(6): 525–530.
- Davies JD, Costa BK, Asciutto AJ. Approaches to manual ventilation. Respir Care. 2014; 59(6): 810–22; discussion 822.
- Lupton JR, Schmicker RH, Stephens S, et al. Outcomes with the use of bag-valve-mask ventilation during out-of-hospital cardiac arrest in the pragmatic airway resuscitation trial. Acad Emerg Med. 2020; 27(5): 366–374.
- Perkins GD, Gräsner JT, Semeraro F, et al. European Resuscitation Council Guidelines 2021: Executive summary. Resuscitation. 2021; 161: 1–60.
- Panchal AR, Bartos JA, Cabañas JG, et al. Adult Basic and Advanced Life Support Writing Group. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142(16_suppl_2): S366–S468.
- Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004; 109(16): 1960–1965.
- Whitehurst ME, Blount AD, Austin PE, et al. Ventilatory strategies affect gas exchange in a pig model of closed-chest cardiac compression. Ann Emerg Med. 1998; 31(5): 568–574.
- Idris AH, Wenzel V, Becker LB, et al. Does hypoxia or hypercarbia independently affect resuscitation from cardiac arrest? Chest. 1995; 108(2): 522–528.
- Scanlon TS, Benumof JL, Wahrenbrock EA, et al. Hypoxic pulmonary vasoconstriction and the ratio of hypoxic lung to perfused normoxic lung. Anesthesiology. 1978; 49(3): 177–181.
- Dunham-Snary K, Wu D, Sykes E, et al. Hypoxic pulmonary vasoconstriction. Chest. 2017; 151(1): 181–192.
- Boussarsar M, Thierry G, Jaber S, et al. Relationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome. Intensive Care Med. 2002; 28(4): 406–413.
- Stone BJ, Chantler PJ, Baskett PJ. The incidence of regurgitation during cardiopulmonary resuscitation: a comparison between the bag valve mask and laryngeal mask airway. Resuscitation. 1998; 38(1): 3–6.
- Weiler N, Heinrichs W, Dick W. Assessment of pulmonary mechanics and gastric inflation pressure during mask ventilation. Prehosp Disaster Med. 1995; 10(2): 101–105.
- Wenzel V, Idris AH, Banner MJ, et al. Influence of tidal volume on the distribution of gas between the lungs and stomach in the nonintubated patient receiving positive-pressure ventilation. Crit Care Med. 1998; 26(2): 364–368.
- Naczelna Izba Pielęgniarek i Położnych. Raport o stanie pielęgniarstwa i położnictwa w Polsce. https://nipip.pl/wp-content/uploads/2023/12/RAPORT-O-STANIE-PIELEGNIARSTWA-I-P-OLOZNICTWA-W-POLSCE-MAJ-2023.pdf (2023).
- Khoury A, Sall FS, De Luca A, et al. Evaluation of bag-valve-mask ventilation in manikin studies: what are the current limitations? Biomed Res Int. 2016: 1–8.
- Khoury A, De Luca A, Sall FS, et al. Ventilation feedback device for manual ventilation in simulated respiratory arrest: a crossover manikin study. Scand J Trauma Resusc Emerg Med. 2019; 27(1): 93.
- Zobrist B, Casmaer M, April MD. Single rescuer ventilation using a bag-valve mask with internal handle: a randomized crossover trial. Am J Emerg Med. 2016; 34(10): 1991–1996.
- Neth MR, Benoit JL, Stolz U, et al. Ventilation in simulated out-of-hospital cardiac arrest resuscitation rarely meets guidelines. Prehosp Emerg Care. 2021; 25(5): 712–720.
- O'Neill JF, Deakin CD. Do we hyperventilate cardiac arrest patients? Resuscitation. 2007; 73(1): 82–85.
- Maertens VL, De Smedt LEG, Lemoyne S, et al. Patients with cardiac arrest are ventilated two times faster than guidelines recommend: an observational prehospital study using tracheal pressure measurement. Resuscitation. 2013; 84(7): 921–926.
- Taylor C, Mattick K, Carrieri D, et al. 'The WOW factors': comparing workforce organization and well-being for doctors, nurses, midwives and paramedics in England. Br Med Bull. 2022; 141(1): 60–79.
- Law JA, Broemling N, Cooper RM, et al. Canadian Airway Focus Group. The difficult airway with recommendations for management--part 2--the anticipated difficult airway. Can J Anaesth. 2013; 60(11): 1119–1138.
- Khan RM, Sharma PK, Kaul N. Airway management in trauma. Indian J Anaesth. 2011; 55(5): 463–469.
- Gruber E, Oberhammer R, Balkenhol K, et al. Basic life support trained nurses ventilate more efficiently with laryngeal mask supreme than with facemask or laryngeal tube suction-disposable--a prospective, randomized clinical trial. Resuscitation. 2014; 85(4): 499–502.
- Zhang K, Zhou M, Zou Z, et al. Supraglottic airway devices: a powerful strategy in airway management. Am J Cancer Res. 2024; 14(1): 16–32.
- Christ M, Auenmüller KIv, Benken Tv, et al. Supraglottische Atemwegssicherung und intraossärer Zugang in der Behandlung von Patienten nach außerklinischem Herz-Kreislauf-Stillstand. Med Klin Intensivmedizin und Notfallmedizin. 2018; 114(5): 426–433.
- Wagner-Berger HG, Wenzel V, Stallinger A, et al. Decreasing peak flow rate with a new bag-valve-mask device: effects on respiratory mechanics, and gas distribution in a bench model of an unprotected airway. Resuscitation. 2003; 57(2): 193–199.
- Hesselfeldt R, Kristensen MS, Rasmussen LS. Evaluation of the airway of the SimMan full-scale patient simulator. Acta Anaesthesiol Scand. 2005; 49(9): 1339–1345.
- De Luca A, Sall FS, Sailley R, et al. Reliability of manikin-based studies: an evaluation of manikin characteristics and their impact on measurements of ventilatory variables. Anaesthesia. 2015; 70(8): 915–921.