Comparison of ventilation performance: standard resuscitation bag and the resuscitation bag controller.

Clinical evaluation of ventilation performance during resuscitation is largely subjective. A mechanical device, the resuscitation bag controller (RC), which encircles the bag and allows controlled compression may improve the precision and accuracy of ventilation with manual resuscitation bags (MRB). We hypothesize that more precise, controlled pressure ventilation can be delivered with the RC, compared to the MRB. Prehospital (N = 13) and hospital personnel (N = 12) who routinely perform manual ventilation were randomized to either method of ventilation. Operators were instructed to ventilate an intubated adult mannequin. The percent of breaths delivered within a specified range, 800 to 1200 mL, was compared using simple regression analysis. The precision of tidal volume (TV) and peak airway pressure (PAP) was compared between methods and groups using the coefficient of variation. Comparison for significant differences between methods and groups in the number of breaths with a TV less than 800 mL and those with pressures greater than 30 cm H20 was performed using chi square or Fisher's exact test. There were no significant differences in the percent of acceptable breaths or mean TV delivered between methods or groups. The precision (i.e., reproducibility of the same value) of TV for both methods was best for hospital personnel. PAPS were less than or equal to 30 cm H2O for 93% of all breaths. Hospital personnel delivered a significantly greater percent of inadequate (less than 0.8 L) breaths, 19 versus 7.4%, and excessive pressure breaths, 9.2 versus 4.2%, when compared to prehospital personnel. We conclude that the resuscitation bag controller offers little advantage over standard bag resuscitation for adult resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of a didactic session on the success of feline endotracheal intubation by paramedics.

Clinical reports of endotracheal (ET) intubation of infants by paramedics suggest suboptimal success rates. Methods to improve the performance of paramedics in ET intubation should be explored. The small, anesthetized cat may be utilized to evaluate infant ET intubation performance. By determining success rates and complications of ET intubation in the cat model, analysis of the current skills and the impact of a short didactic session is described. Unprepared paramedics (n = 36) were randomized to an educational (experimental) or control group. Supervisory personnel evaluated ET tube placement and complications. There was no significant difference in the percent of successfully intubated cats, 67% and 57%, respectively, between experimental and control groups. Fifteen percent of successful ET intubations exceeded 30 seconds of intubation time. The experimental group chose appropriate equipment more frequently. Serious complications occurred in 50% of attempted intubations. There was a poor correlation between performance and measures of paramedic experience. Development of educational methods is required to improve infant ET intubation success and reduce complications.

A comparison of infant ventilation methods performed by prehospital personnel.

By comparing mouth-to-mouth ventilation to other methods, we tested whether there are significant differences among infant mannequin ventilation methods performed by emergency medical technicians-paramedics (EMT-Ps). Fifty-nine participants were evaluated in the performance of six ventilation methods; methods studied were mouth-to-mouth; two mouth-to-mask devices; and infant, pediatric, and adult bag-valve-mask devices. By measuring each breath, the percentage of acceptable ventilations in predetermined ranges, 5 to 25 mL/kg or 10 to 20 mL/kg, was calculated. Methods were compared using repeat measures ANOVA testing. Correlation between ventilation performance and the experience of personnel was expressed as the Pearson correlation coefficient. There were no significant differences in performance between methods, except for inadequate ventilation with the Laerdal Pocket Mask (P less than .05) from poor mask fit. The correlation between years of prehospital experience and the number of resuscitations versus ventilation performance was poor. Single rescuer, EMT-Ps can successfully ventilate an infant mannequin with various size resuscitation bags. The Laerdal Pocket Mask is an ineffective device for infant mannequin ventilation and should not be recommended for infant resuscitation.