Bag-mask ventilation by low- or untrained rescuers during resuscitation: a randomised cross-over study

Objective: Bag-mask ventilation (BMV) forms a cornerstone during advanced cardiopulmonary resuscitation (CPR), as opposed to lay settings applying mouth-to-mouth ventilation. The latter is contraindicated in case of potential disease transmission (COVID pandemic). This study explores the degree of training needed for rescuers to effectively perform BMV during CPR. Methods: We performed a randomized crossover manikin study (Laerdal’s Resusci Anne QCPR - Resusci Baby QCPR) with 112 medical students: 60 first years (untrained) and 52 fourth years (low-trained), excluding BLS certificate holders or lifeguards. After dividing students into duos within their year and a 15 minute just-in-time training in full CPR-cycle using BMV, each pair was tested during 5 cycles of 2-person CPR following the ERC guidelines. In infants, initial rescue breaths used 1-person BMV. Correct ventilations included tidal volumes of 300– 600 ml (adults) and 20–60 ml (infants). Results: Correctly administered ventilations during adult CPR using BMV showed no statistically significant difference between low- and untrained rescuers (first years: 63,0%;fourth years: 59,5%;proportional difference − 3.5% [−12.8;5.9]). A significant difference was observed in infant CPR, both in effective ventilations (first years: 55,5%;fourth years: 72,3%;proportional difference 16.8 [7.25;26.21]) and initial rescue breaths (first years: 54,1%;fourth years: 72,0%;proportional difference 17.9 [5.36;30.50]). Of the remaining 39 pairs after exclusion of 17 (n = 56) for incorrect numbers of ventilation or uninterpretable values, 15 duo’s (38,5%) accomplishes efficient ventilations using BMV. Comparison by year unveils 40,9% untrained rescuers performing efficient ventilations versus 35,3% low-trained rescuers. Inclusion of all 56 groups shows 27,8% performing correct ventilations. Conclusion:With 1/3 of low- and untrained participants performing effective BMV during CPR following a just-in-time training prior to testing, the difference between both groups was small, reaching significance in infant ventilations. In conclusion, 2-person BMV is a complex skill requiring sufficient and regular training

European Resuscitation Council COVID-19 guidelines executive summary.

Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person's presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.