title: Mouth-to-mouth ventilation is superior to mouth-to-pocket mask and bag-valve-mask ventilation during lifeguard CPR: a randomized study.
abstract: OBJECTIVE
  The quality of cardiopulmonary resuscitation (CPR) is a crucial determinant of outcome following cardiac arrest. Interruptions in chest compressions are detrimental. We aimed to compare the effect of mouth-to-mouth ventilation (MMV), mouth-to-pocket mask ventilation (MPV) and bag-valve-mask ventilation (BMV) on the quality of CPR.
  
  
  METHODS
  Surf lifeguards in active service were included in the study. Each surf lifeguard was randomized to perform three sessions of single-rescuer CPR using each of the three ventilation techniques (MMV, MPV and BMV) separated by 5 min of rest. Data were obtained from a resuscitation manikin and video recordings.
  
  
  RESULTS
  A total of 60 surf lifeguards were included (67% male, 33% female, mean age 25 years). Interruptions in chest compressions were significantly reduced by MMV (8.9 ± 1.6 s) when compared to MPV (10.7 ± 3.0 s, P < 0.001) and BMV (12.5 ± 3.5s, P < 0.001). Significantly more effective ventilations (visible chest rise) were delivered using MMV (91%) when compared to MPV (79%, P < 0.001) and BMV (59%, P < 0.001). The inspiratory time was longer during MMV (0.7 ± 0.2 s) and MPV (0.7 ± 0.2s, P < 0.001 for both) compared to BMV (0.5 ± 0.2s). Tidal volumes were significantly lower using BMV (0.4 ± 0.2L) compared to MMV (0.6 ± 0.2L, P < 0.001) and MPV (0.6 ± 0.3 L, P < 0.001), whereas no differences were observed when comparing MMV and MPV.
  
  
  CONCLUSIONS
  MMV reduces interruptions in chest compressions and produces a higher proportion of effective ventilations during lifeguard CPR. This suggests that CPR quality is improved using MMV compared to MPV and BMV.
authors.affiliation: Faculty of Health Sciences, Aarhus University, Denmark.
authors.forename: Kasper
authors.initials: K
authors.lastname: Adelborg
authors.forename: Christian
authors.initials: C
authors.lastname: Dalgas
authors.forename: Erik Lerkevang
authors.initials: EL
authors.lastname: Grove
authors.forename: Carsten
authors.initials: C
authors.lastname: Jørgensen
authors.forename: Rozh Husain
authors.initials: RH
authors.lastname: Al-Mashhadi
authors.forename: Bo
authors.initials: B
authors.lastname: Løfgren
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008348:Manikins; D008397:Masks; D012121:Respiration, Artificial / Q000295:instrumentation*