Use of self-inflating bags for neonatal resuscitation☆
Introduction
Neonatal resuscitation depends on achieving adequate lung inflation. Based on studies from the 1970s and the published Consensus from the International Liaison Committee on Resuscitation (ILCOR), current UK guidance recommends that initial lung inflation pressure in newborn term infants should be 30 cm, sustained over 2–3 s [1], [2], [3], [4]. Paediatricians use a range of devices to achieve lung inflation in neonatal resuscitation (table) [5]. Relatively little research is available to guide their choice of device [5].
The Newborn Life Support (NLS) course is designed to equip novices in neonatal resuscitation with practical skills and prepare them for clinical practice. It has been administered by the Resuscitation Council of the United Kingdom since 1999 and is similar in its inception to the Newborn Resuscitation programme (NRP) in the United States [4], [6]. Instructors are selected by performing well on the course, having significant experience of neonatal resuscitation and an aptitude to teach. All instructors have undergone a 3-day instructor course and further mentored training.
We set out to test the hypothesis that trained Newborn Life Support candidates and instructors could deliver initial inflation breaths conforming to UK recommendations using the three devices commonly used in our region. We also wished to compare the performance of instructors and trained candidates.
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Methods
Candidates and instructors attending an NLS course were enrolled voluntarily in the study. They were asked them to deliver “initial inflation breaths as you have been shown on the course” to the apparatus. If candidates sought clarification, it was confirmed that this meant 2–3 s inflations.
Candidates and instructors delivered breaths using each of a self-inflating 500-ml bag with integral 40 cm H2O blow-off valve (Laerdal Medical, Stavanger, Norway), a 240-ml self-inflating bag with 40 cm H2O
Results
Ninety-one breaths from 18 subjects (7 instructors, 11 candidates) were suitable for analysis. These comprised 31 using a “Tom Thumb”, 35 breaths using a 500-ml bag and 25 breaths delivered using a 240-ml bag. Results are presented graphically. In Fig. 1, Fig. 2, the left hand column represents experimental breaths delivered by a candidate using a “Tom Thumb” device to a high compliance lung, and columns to the right show the effect of varying one component of the experimental system.
Using a
Discussion
This study has demonstrated that neither candidates nor instructors on a newborn life support course are able to deliver breaths conforming reliably to standard criteria when using self-inflating bags. Although breaths delivered with a 500-ml self-inflating bag were of adequate duration much of inspiration was outside the target pressure range. Worryingly we have shown that in relatively stress-free laboratory conditions, where a self-inflating bag is used, both instructors and candidates
Conclusions
Our work does not support the use of the infant (240-ml) Laerdal bag for newborn resuscitation and suggests that even the paediatric (500-ml) Laerdal bag should be used with caution. We believe this work supports wider use in term infants of a variable pressure blow-off system such as the “Tom Thumb” or the “Neopuff”, which also provides for variable positive end expiratory pressure. Such devices can only however be relied on when a secure gas supply can be provided, which may not be the case
Conflict of interest
Sam Oddie and Jonathan Wyllie both have longstanding voluntary involvement in Newborn Life Support Course training.
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Cited by (0)
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A Spanish translated version of the abstract of this article appears as Appendix at 10.1016/j.resuscitation.2005.05.004.