title: Impact of a pressure-responsive flow-limiting valve on bag-valve-mask ventilation in an airway model.
abstract: OBJECTIVE
  Using a simulated airway model, we compared ventilation performance by emergency medical services (EMS) providers using a traditional bag-valve-mask (Easy Grip) resuscitator to their performance when using a new device, the SMART BAG resuscitator, which has a pressure-responsive flow-limiting valve.
  
  
  METHODS
  We recruited EMS providers at an EMS educational forum and performed a randomized, non-blinded, prospective crossover comparison of ventilation with 2 devices on a non-intubated simulated airway model. Subjects were instructed to ventilate a Mini Ventilation Training Analyzer as they would an 85-kg adult patient in respiratory arrest. After being randomized to order of device use, they performed ventilation for 1 minute with each device. Primary outcomes were ventilation rates and peak airway pressures. We also measured average tidal volume, gastric inflation volume, minute ventilation and inspiratory:expiratory (I:E) ratio, and compared our results to the American Heart Association standards (2005 edition).
  
  
  RESULTS
  We observed statistically significant differences between the SMART BAG and the traditional bag-valve-mask for respiratory rate (12 v. 14 breaths/min), peak airway pressure (15.6 v. 18.9 cm H(2)O), gastric inflation (239.6 v. 1598.4 mL), minute ventilation (7980 v. 8775 mL), and I:E ratio (1.3 v. 1.1). Average tidal volume was similar with both devices (679.6 v. 672.2 mL).
  
  
  CONCLUSIONS
  The SMART BAG(R) provided ventilation performance that was more consistent with American Heart Association guidelines and delivered similar tidal volumes when compared with ventilation with a traditional bag-valve-mask resuscitator.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28203, USA. jbuskomd@yahoo.com
authors.forename: Jonnathan M
authors.initials: JM
authors.lastname: Busko
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Blackwell
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D005500:Follow-Up Studies; D006801:Humans; D008397:Masks; D008962:Models, Theoretical; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume