Comparison of self-inflating bags with anesthesia bags for bag-mask ventilation in the pediatric emergency department.
OBJECTIVE
To compare bag-mask ventilation performed by emergency department (ED) personnel using anesthesia bags (AB) and self-inflating bags (SIB).


METHODS
ED in a teaching children's hospital where the AB is the device used during resuscitations.


METHODS
Experimental study. Bag-mask ventilation was evaluated with an infant resuscitation mannequin equipped to measure airway volumes and pressures. Pediatric residents, ED nurses, and pediatric emergency medicine fellows performed bag-mask ventilation with AB and SIB and rated their confidence using each device.


METHODS
Ventilation failure rates.


RESULTS
Seventy subjects participated (17 interns, 16 junior residents, 13 senior residents, 10 fellows, and 14 nurses). There were 13 failures with the AB (18.6%) versus 1 (1.4%) with the SIB (P < 0.01) [95% confidence interval: 5-29%], with a significant difference even after excluding the least experienced subjects. There was no difference in high pressure breaths delivered (SIB 19% vs AB 15%, P = 0.4) and a higher incidence of hyperventilation with the SIB (67 vs 25%, P < 0.01). While using the SIB, 19 (27%) of the subjects did not turn on the O2 flow. There was no difference in pretest confidence rating, but the posttest confidence rating was higher for the SIB (P < 0.05).


CONCLUSIONS
Compared to SIB use for bag-mask ventilation in an ED, AB use resulted in more ventilation failures, no advantage in preventing excessive airway pressures, and less confidence among operators. The SIB should be the first choice for bag-mask ventilation in the ED, with attention to maximize oxygen delivery.
Mondolfi
A A
AA
Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA.
Grenier
B M
BM
Thompson
J E
JE
Bachur
R G
RG
D000776:Anesthesiology / Q000295:instrumentation; D016638:Critical Illness; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D004868:Equipment Failure; D005069:Evaluation Studies as Topic; D006801:Humans; D007223:Infant; D008348:Manikins; D008397:Masks; D010372:Pediatrics; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000628:therapy*; D012151:Resuscitation / Q000295:instrumentation