title: Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation.
abstract: BACKGROUND
  Suboptimal bag ventilation in cardiopulmonary resuscitation (CPR) has demonstrated detrimental physiological outcomes for cardiac arrest patients. In light of recent guideline changes for resuscitation, there is a need to identify the efficacy of bag ventilation by prehospital care providers. The objective of this study was to evaluate bag ventilation in relation to operator ability to achieve guideline consistent ventilation rate, tidal volume and minute volume when using two different capacity self-inflating bags in an undergraduate paramedic cohort.
  
  
  METHODS
  An experimental study using a mechanical lung model and a simulated adult cardiac arrest to assess the ventilation ability of third year Monash University undergraduate paramedic students. Participants were instructed to ventilate using 1600 ml and 1000 ml bags for a length of two minutes at the correct rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Ethics approval was granted.
  
  
  RESULTS
  Suboptimal ventilation with the use of conventional 1600 ml bag was common, with 77% and 97% of participants unable to achieve guideline consistent ventilation rates and tidal volumes respectively. Reduced levels of suboptimal ventilation arouse from the use of the smaller bag with a 27% reduction in suboptimal tidal volumes (p = 0.015) and 23% reduction in suboptimal minute volumes (p = 0.045).
  
  
  CONCLUSIONS
  Smaller self-inflating bags reduce the incidence of suboptimal tidal volumes and minute volumes and produce greater guideline consistent results for cardiac arrest patients.
authors.affiliation: Monash University, Department of Community Emergency Health and Paramedic Practice, PO Box 527, Frankston 3199, Victoria, Australia. Ziad.Nehme@med.monash.edu.au
authors.forename: Ziad
authors.initials: Z
authors.lastname: Nehme
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Boyle
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004634:Emergency Medical Technicians; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012107:Research Design; D012121:Respiration, Artificial / Q000295:instrumentation*; D013990:Tidal Volume / Q000502:physiology; D014739:Victoria; D055815:Young Adult