ABSTRACT
BACKGROUND: The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device. METHODS: This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV). RESULTS: A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0-2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0-467.3] mL/min, P < .001). CONCLUSIONS: Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject.
ABSTRACT
STUDY OBJECTIVE: This study evaluated the association of race and socioeconomic status with the rate of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest in Memphis, TN and compared it to 25 years prior. METHODS: This was a retrospective cross-sectional study of out-of-hospital cardiac arrest events in the Memphis area from 2012-2018. The primary outcome of interest was the provision of bystander CPR. Socioeconomic status was estimated using the Economic Hardship Index model. A generalized linear mixed model analysis was conducted. RESULTS: The overall rate of bystander CPR was 33.6%. White patients were more likely to receive bystander CPR compared to black patients (44.0% vs 29.8%, adjusted odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.40-2.05). Patients in areas of increased economic hardship were less likely to receive bystander CPR (OR = 0.713, 95% CI = 0.569-0.894). Overall bystander CPR rate increased by 18.7% over the past 25 years. CONCLUSION: Despite significant increases in bystander CPR compared to 25 years ago, black individuals are still less likely to receive bystander CPR than white individuals in Memphis. Both race and socioeconomic status were independent predictors of the rate of bystander CPR. By using neighborhood demographics and the Economic Hardship Index, communities with low overall bystander CPR rates, such as Memphis, can focus limited resources on areas of greatest need and potential effectiveness.
