Comparative Evaluation of Effectiveness of Two-handed E-C Clamp Technique versus V-E Technique in Patients with Predicted Difficult Mask Ventilation

Abstract

Abstract Background: The skill of bag mask ventilation (BMV) remains pivotal during airway management for maintenance of oxygenation in apneic unconscious patients. Two-handed BMV techniques viz., the traditional E-C and V-E have been proven to be superior to one-handed techniques in optimizing BMV in difficult mask ventilation (DMV) scenarios. Aims and Objectives: This study aimed to compare the effectiveness of these two techniques of BMV in adult patients with predicted DMV. Methods: Four hundred ASA I-III adult patients with predictors of DMV received BMV after induction of anaesthesia using E-C clamp and V-E techniques in a randomized cross-over manner. Ventilator was set to VCV mode delivering tidal volume of 7 ml/kg, respiratory rate of 10 breaths per minute, and no PEEP. The primary outcome was exhaled tidal volume (Vte) and secondary outcomes analysed included air-leak, peak inspiratory pressure (PIP), end-tidal carbon dioxide (EtCO2), minute ventilation (MV), plateau pressure and SpO2. Results: Two-handed V-E technique generated significantly higher mean Vte of 377.83 ± 58.43 ml as compared to two-handed E-C technique (303.26 ± 103.34 ml). The air-leak was found to be significantly more with E-C technique (131.05 ml ± 100.95 ml) as compared to V-E technique (59.08 ± 49.62 ml). Higher EtCO2, MV with concomitant lower airway pressures were observed with V-E technique. Failure rate of BMV was significantly higher with E-C technique (19%) as compared to V-E technique (1%) (P = 0.001). Conclusion: Two-handed V-E technique results in more effective ventilation as compared to two-handed E-C technique in patients with predictors of difficult BMV. This technique may be preferred as a first option in patients with anticipated DMV.