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Prehospital Pediatric Ventilation Quality Following Use of a Feedback Device: A Randomized Study
Joseph D Finney1,2, Jeffrey Siegler2, Jinli Wang3
1Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri.
Objective:
Manual ventilation is a lifesaving intervention for children in respiratory arrest, yet the quality of pediatric ventilation delivered by emergency medical services (EMS) clinicians across geographically distinct sites is poorly characterized. We evaluated baseline EMS ventilation performance and whether a ventilation feedback device (VFD) improves adherence to national and international ventilation guidelines for ventilation rate, tidal volume, and mask seal.
Methods:
We conducted a single-anonymized, randomized, crossover study of EMS clinicians from 5 EMS agencies across 3 metropolitan sites in the United States. Using a simulated 3-year-old toddler manikin, participants completed 2 sequential 2-minute respiratory arrest scenarios separated by a 10-minute washout period. Participants performed ventilation with and without real-time VFD feedback in randomized order. The EOLifeX VFD recorded ventilation rate, tidal volume, and mask leak with each breath. Adherence to age-based guidelines was analyzed using generalized linear mixed-effects models with participants nested within sites.
Results:
We enrolled 123 participants across 5 agencies. With VFD feedback, guideline-recommended tidal volumes were achieved in 87% of breaths compared with 16.2% without feedback. Ventilation rate adherence improved from 65% to 88.6%. Mask leak of less than 30% occurred in 88.4% of ventilations with feedback vs 80% without feedback.
Conclusion:
In our simulation study, EMS clinicians rarely met manual ventilation guidelines for pediatric patients in respiratory arrest. The use of a VFD substantially improved guideline adherence, suggesting broad potential to improve ventilation performance.
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A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
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Noninvasive Positive-Pressure Ventilation (NIPPV)
Mechanical Ventilation I: Indication and Settings
Mechanical Ventilation II: Invasive Ventilation
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Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
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Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
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