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Open AccessArticle

Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial

1
Department of Anaesthesiology, Bethesda Hospital, 47053 Duisburg, Germany
2
Department of Anaesthesiology 1, Witten/Herdecke University, 58455 Witten, Germany
3
Institution for Emergency Medicine, 59755 Arnsberg, Germany
4
Department of Intensive Care, University Hospital, 4031 Basel, Switzerland
*
Author to whom correspondence should be addressed.
These two authors contributed equally to the work.
J. Clin. Med. 2020, 9(7), 2045; https://doi.org/10.3390/jcm9072045
Received: 3 June 2020 / Revised: 16 June 2020 / Accepted: 23 June 2020 / Published: 29 June 2020
(This article belongs to the Section Emergency Medicine)
The role of advanced airway management (AAM) in cardiopulmonary resuscitation (CPR) is currently debated as observational studies reported better outcomes after bag-mask ventilation (BMV), and the only prospective randomized trial was inconclusive. Adherence to CPR guidelines ventilation recommendations is unknown and difficult to assess in clinical trials. This study compared AAM and BMV with regard to adherence to ventilation recommendations and chest compression fractions in simulated cardiac arrests. A total of 154 teams of 3–4 physicians were randomized to perform CPR with resuscitation equipment restricting airway management to BMV only or equipment allowing for all forms of AAM. BMV teams ventilated 6 ± 6/min and AAM teams 19 ± 8/min (range 3–42/min; p < 0.0001 vs. BMV). 68/78 BMV teams and 23/71 AAM teams adhered to the ventilation recommendations (p < 0.0001). BMV teams had lower compression fractions than AAM teams (78 ± 7% vs. 86 ± 6%, p < 0.0001) resulting entirely from higher no-flow times for ventilation (9 ± 4% vs. 3 ± 3 %; p < 0.0001). Compared to BMV, AAM leads to significant hyperventilation and lower adherence to ventilation recommendations but favourable compression fractions. The cumulative effect of deviations from ventilation recommendations has the potential to blur findings in clinical trials. View Full-Text
Keywords: cardiopulmonary resuscitation; randomized controlled trial; bag-mask ventilation; advanced airway management; simulation cardiopulmonary resuscitation; randomized controlled trial; bag-mask ventilation; advanced airway management; simulation
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Vogt, L.; Sellmann, T.; Wetzchewald, D.; Schwager, H.; Russo, S.; Marsch, S. Effects of Bag Mask Ventilation and Advanced Airway Management on Adherence to Ventilation Recommendations and Chest Compression Fraction: A Prospective Randomized Simulator-Based Trial. J. Clin. Med. 2020, 9, 2045.

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