It takes two: development of simulation training for two-handed neonatal mask ventilation integrating a respiratory...

Facemask leak is common with a one-handed hold and can reduce the efficacy of neonatal resuscitation. Our objective was to assess a standardised, respiratory function monitor (RFM)-guided training intervention for two-handed neonatal positive pressure ventilation (PPV).

Development of a two-handed PPV training algorithm occurred through an iterative process with learner and expert feedback. Participants performed PPV via a facemask on a term manikin with feedback from the RFM display (Monivent Neo100). We first piloted the training intervention on ten clinicians over six sessions. The intervention was then assessed through a before-and-after, non-randomised simulation-based study, blinded to the RFM, comparing mask leak, tidal volume and participant feedback. Mask hold style and hand preference were recorded.

Prior to the intervention, 17/40 (42%) had previously used two-handed PPV in clinical practice. Forty clinicians were included in the training study. Mask leak was significantly lower with a two-handed hold before training: one-handed median 27%, (IQR 3-73%) vs two-handed: 2.5% (1-31%), p < 0.01 median difference (95% CI) of -5.5 (-23 to -1). Post-training mask leak was comparable between holds: one-handed median 6% (IQR 2-55%); and two-handed 2% (0-5%), p < 0.01 median difference (95% CI) -4 (-18 to -1). Pre-training, 11/40 (27%) preferred two-handed compared with one-handed PPV. Following training 20/40 (50%) preferred two-handed.

Effective facemask ventilation in a neonatal manikin was associated with a two-handed hold without training or prior clinical experience. After training facemask leak was low with both holds. Feedback indicated increased participant preference for two-handed PPV after training.