Airway management by first responders when using a bag-valve device and two oxygen-driven resuscitators in 104 patients.
OBJECTIVE
To evaluate the capability of first responders to ensure an airway and ventilate the lungs of a patient employing a bag-valve device and two oxygen-driven resuscitators.


METHODS
Prospective, controlled, blinded, single-centre clinical trial using a bag-valve device and one of two FR-300 devices, with 20 cmH2O working pressure, flows of 24 and 30 L min(-1). One-hundred-and-four patients were analysed. Induction of anaesthesia was followed by ventilation of the lungs with a bag-valve device and an Oxylator (CPR Medical Devices Corp., Markham, Ontario, Canada) in manual and automatic modes. Each series was repeated twice by a fireman first responder using a hand-held mask to seal the airway, once under anaesthesia and then again under anaesthesia with muscle relaxation.


RESULTS
Patients' mean age 49 +/- 17 yr; 47% male, 48-132 kg. Only 29% had optimal facial and airway physiognomy. Airway management was significantly poorer when the bag-valve device was used than with either Oxylator mode (P < 0.0001); 23% of cases were not manageable with the bag-valve device. Gastric insufflation was markedly less with the Oxylator (P < 0.02).


CONCLUSIONS
The use of an oxygen-driven device improves the ability of first responders to secure an airway and reduce gastric insufflation, even when distracted. Oxylators perform significantly better (P < 0.0001) than the bag-valve device.
Noordergraaf
G J
GJ
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands. g.noordergraaf@elisabeth.nl
van Dun
P J
PJ
Kramer
B P
BP
Schors
M P
MP
Hornman
H P
HP
de Jong
W
W
Noordergraaf
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D007327:Insufflation; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D017409:Sufentanil / Q000627:therapeutic use; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data*
D018686:Anesthetics, Intravenous; D009125:Muscle Relaxants, Central; D017409:Sufentanil; D015742:Propofol