To intubate or not: ventilation is the question. A manikin-based observational study

Area of Science:

• Emergency Medicine
• Respiratory Care
• Cardiopulmonary Resuscitation

Background:

• The debate on the superiority of endotracheal intubation versus bag-valve-mask (BVM) ventilation in cardiac arrest patients persists.
• This study evaluates manual ventilation performance using both facemask (BVM) and endotracheal tube (ETT) interfaces.

Purpose of the Study:

• To compare the effectiveness of manual ventilation between BVM and ETT in a manikin model.
• To identify factors influencing manual ventilation performance in healthcare providers.

Main Methods:

• 140 healthcare providers performed 5-minute manual ventilations on a manikin using both BVM and ETT in random order.
• Ventilatory parameters were measured using the ASL 5000 lung simulator.
• Performance was analyzed using a sliding window method to assess ventilation efficiency.

Main Results:

• High ventilation rates (mean 24 bpm) were observed for both techniques, exceeding guidelines.
• Adequate ventilation rates were low (7.5% for BVM, 13.21% for ETT), with no significant difference in hyperventilation rates (79% vs 77%).
• Professional category and hand size significantly impacted ventilation performance.

Conclusions:

• Healthcare professionals face challenges in performing efficient manual ventilation with current devices, irrespective of the interface used.
• Endotracheal intubation did not demonstrate significantly superior ventilation efficiency compared to facemask ventilation.
• Improving training and focusing on controlling ventilatory parameters are crucial for enhancing manual ventilation efficiency during cardiopulmonary resuscitation.