Infant Ventilation and Oxygenation by Basic Life Support Providers: Comparison of Methods

Abstract

AbstractIntroduction:Little information is available in the performance of infant ventilation by basic life support (BLS) personnel.Hypothesis:There are no significant differences between mouth-to-mouth (M-M), mouth-to-mask (M-Ma), pediatric bag-mask (PBM), and adult bag-mask (ABM) devices in the percent of acceptable breaths delivered by BLS providers.Methods:Fifty certified BLS providers performed five ventilation methods in random sequences for 60 seconds each on a 5kg infant mannequin following standardized instructions. Supplemental oxygen, 10 l/min, was supplied with one M-Ma trial and PBM methods. Airway patency, peak airway pressure (PAP), ventilatory rate (VR), tidal volume, and delivered oxygen concentration (FiO2) were recorded. The percent of breaths with excessive PAP (i.e., >30 mmHg), percent of acceptable breaths using loose (i.e., 25−125ml) and strict (i.e., 50−100ml) criteria, and FiO2 at at 15, 30, 45, and 60 seconds were compared between ventilation methods using ANOVA.Results:For all subjects and those with a patent airway (n=36), there were no significant differences in the percentage of acceptable breaths between the respective ventilation methods using loose or strict criteria. The proportion of excessive breaths produced by PBM (56±6) (mean±SEM; all subjects) and ABM (41±6.2) was significantly greater than M-Ma, with and without a patent airway. Although RR and the percentage of excessive breaths were not significantly different, the percentage of acceptable breaths and FiO2 delivered with each ventilation method was significantly better in the patent airway group.Conclusion:For BLS providers, M-Ma ventilation with supplemental O2 provided the best method of initial infant ventilation based upon the percent of acceptable breaths, oxygen delivery, and fewest excessive pressure breaths.