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Cardiopulmonary Resuscitation II: ACLS Airway Management01:22

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Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
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Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
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Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
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Updated: Aug 15, 2025

Laryngeal Mask Airway LMA Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway SGA
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Five vs. two initial rescue breaths during infant basic life support: A manikin study using bag-mask-ventilation.

Anke Geerts1, Sandrine Herbelet1, Gautier Borremans1

  • 1Department of Basic and Applied Medical Sciences (BAMS), Ghent University, Ghent University Hospital, Ghent, Belgium.

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|December 30, 2022
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Summary

Five initial rescue breaths [IRB] in infant cardiopulmonary resuscitation [CPR] significantly increase the success rate of delivering effective ventilations. This finding supports current European Resuscitation Council guidelines for pediatric resuscitation.

Keywords:
BLSbag-mask ventilationinfant CPRinitial rescue breathsmanikin studypediatric

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Area of Science:

  • Pediatric Emergency Medicine
  • Cardiopulmonary Resuscitation (CPR)
  • Medical Education

Background:

  • Hypoxic-ischemic events are a common cause of cardiac arrest in children.
  • Early ventilation is crucial for improving outcomes in pediatric CPR.
  • European Resuscitation Council guidelines recommend five initial rescue breaths (IRB) for infants, based on the hypothesis that five attempts may be needed for two effective ventilations.

Purpose of the Study:

  • To verify the hypothesis that five initial rescue breaths are necessary for effective infant ventilation during CPR.
  • To assess the success rate of delivering effective ventilations with varying numbers of IRB attempts.

Main Methods:

  • A manikin study involving 112 medical students trained in basic mask ventilation (BMV) for infant CPR.
  • Participants performed 2-person CPR, with 1-person BMV for IRB.
  • Effective ventilation was defined as a tidal volume between 20 and 60 ml, measured using a Laerdal® Q-CPR device.

Main Results:

  • 55.3% of duos achieved effective ventilation within the first two IRB attempts.
  • Allowing up to five IRB attempts increased the success rate to 72.4%.
  • This represents a significant proportional difference of 17.0% (95% CI: 5.4; 28.0).

Conclusions:

  • Five initial rescue breaths in infant CPR using BMV improve the success rate of delivering two effective ventilations.
  • The study findings provide evidence supporting the European Resuscitation Council's recommendation for five IRB.
  • This research reinforces the importance of adequate initial ventilation in pediatric resuscitation protocols.