Article Summary
1. Why is this topic important? Face-mask ventilation is the most important airway skill. This study compares the traditional
2. What does this study attempt to show?
Face-mask (FM), or bag-valve-mask, ventilation is the single most important skill for emergent airway management. Although the FM method of ventilation seems to be simple, it can be difficult to perform correctly and effectively. Proper position of the head and neck, manually opening the airway with a jaw thrust maneuver, placing a nasopharyngeal or oropharyngeal airway device, and achieving a tight face mask seal are the keys to successful FM ventilation 1, 2, 3.
There are multiple techniques for hand positioning during FM ventilation, including the one-handed C-E technique (Figure 1), the two-handed C-E technique (Figure 2), and the alternative technique, which we will refer to as the V-E technique (Figure 3). Despite the importance of this skill, there have only been a few studies comparing the efficacy of these techniques in adults. To our knowledge, there are no studies comparing the various two-handed methods, which include the two-handed C-E technique and the V-E technique, which is taught in a few airway courses (1).
The double C-E technique is the only two-handed method taught in the American Heart Association Courses (Basic Life Support, and Advanced Cardiac Life Support) and cited in major anesthesia textbooks for FM ventilation 2, 3, 4, 5. Some practitioners prefer the alternative V-E technique. Our aim is to compare the efficacy of FM ventilation using these three techniques on a difficult airway model.
Institutional review board approval was obtained for this prospective randomized study of health care providers.
This study took place in an Emergency Department (ED) in a large Level I trauma center.
Eligible subjects were health care providers in the ED, including Emergency Medicine (EM) attending physicians, residents (EM residents and residents from other programs rotating in the ED), physician assistants, nurses, paramedics, and respiratory therapists. Exclusion criteria were subjects who
Seventy subjects were enrolled in the study. One subject did not complete measurements, leaving 69 for analysis. All 69 did three techniques; 6280 breaths were measured; mean volume and pressure for each subject at each technique were determined for analysis. The median was 30 breaths per subject per technique, range 26–38 (each technique was done for 3 min). There were 13 EM attending physicians, 20 EM residents, six residents of other specialties, seven physician assistants, 13 nurses, three
Although it is generally accepted that two-handed FM ventilation is superior to one-handed FM ventilation, our study is the first to compare the two-handed C-E technique with the two-handed V-E technique. There are a number of studies that have compared the one-handed C-E technique (Figure 1) to the two-handed C-E technique (Figure 2), all of which found that the two-handed C-E technique was more effective 6, 11, 12, 13, 14, 15. Some of these studies compared various one-handed techniques to
Two-handed FM ventilation is more effective than one-handed FM ventilation, in both routine and difficult airway situations. We found no significant difference between the two-handed C-E technique and the two-handed V-E technique in this study. However, each health care provider had variable success with each technique. Therefore, it seems that teaching both techniques for airway training may be optimal. 1. Why is this topic important? Face-mask ventilation is the most important airway skill. This study compares the traditional Article Summary
2. What does this study attempt to show?