Comparing the Efficacy of SMART Bag-Valve Ventilation to Traditional Adult and Pediatric Bag-Valve Ventilation During Simulated Out-Of-Hospital Cardiopulmonary Resuscitation
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Abstract
Aim: Optimal Bag Valve Mask (BVM) ventilation is crucial during the management of cardiac arrest because it provides essential oxygen to patients, improving chances of survival until advanced care becomes available. Clinicians oftentimes hyperventilate patients leading to increased risk of aspiration and barotrauma. The SMART BVM has been released incorporating a pressure-responsive valve limiting air flow if/when the operator is hyperventilating. The aim of this study was to compare mean ventilation rates, singular tidal volume and one-minute volume of asynchronous ventilations between the SMART BVM, the more traditionally used Adult BVM, and the Paediatric BVM during an out-of-hospital cardiopulmonary resuscitation simulation amongst a group of novice paramedicine students.
Methods: Thirty paramedic students, working in pairs, completed three simulated cardiopulmonary resuscitation exercises (SIMEXS) utilising the three BVM’s (randomised order of exposure) lasting four-minutes each with one participant providing two-minutes of asynchronous ventilations and the second participant providing chest compressions at a rate of 100–120 per minute for two-minutes before defibrillating. Measures of ventilation rates, singular tidal volume and one-minute volume were taken for comparison against international recommendations.
Results: The SMART and Adult BVM mean ventilation rates were within recommended guideline parameters (i.e., 10–12 BPM). Adult BVM mean singular tidal volume (524mLs) and one-minute volume (5894mLs) were not dissimilar to the International Liaison Committee on Resuscitation (ILCOR) recommendations (i.e., 500mLs per inspiration and 5000–6000 mLs minute volume). However, mean tidal volumes for the SMART BVM and Paediatric BVM were below ILCOR recommendations (443mLs and 280mLs, respectively), as was the Paediatric BVM mean one-minute volume (2992mLs).
Conclusion: In a simulated out-of-hospital cardiac resuscitation, novice students were able to meet ILCOR recommendations for tidal and one-minute volume using a standard Adult BVM; however, they were unable to meet guidelines when using the Paediatric and SMART BVM.
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