title: Efficacy of facemask ventilation techniques in novice providers.
abstract: OBJECTIVE
  To determine which of two facemask grip techniques for two-person facemask ventilation was more effective in novice clinicians, the traditional E-C clamp (EC) grip or a thenar eminence (TE) technique.
  
  
  METHODS
  Prospective, randomized, crossover comparison study.
  
  
  METHODS
  Operating room of a university hospital.
  
  
  METHODS
  60 novice clinicians (medical and paramedic students).
  
  
  METHODS
  Subjects were assigned to perform, in a random order, each of the two mask-grip techniques on consenting ASA physical status 1, 2, and 3 patients undergoing elective general anesthesia while the ventilator delivered a fixed 500 mL tidal volume (VT). In a crossover manner, subjects performed each facemask ventilation technique (EC and TE) for one minute (12 breaths/min). The primary outcome was the mean expired VT compared between techniques. As a secondary outcome, we examined mean peak inspiratory pressure (PIP).
  
  
  RESULTS
  The TE grip provided greater expired VT (379 mL vs 269 mL), with a mean difference of 110 mL (P < 0.0001; 95% CI: 65, 157). Using the EC grip first had an average VT improvement of 200 mL after crossover to the TE grip (95% CI: 134, 267). When the TE grip was used first, mean VTs were greater than for EC by 24 mL (95% CI: -25, 74). When considering only the first 12 breaths delivered (prior to crossover), the TE grip resulted in mean VTs of 339 mL vs 221 mL for the EC grip (P = 0.0128; 95% CI: 26, 209). There was no significant difference in PIP values using the two grips: the TE mean (SD) was 14.2 (7.0) cm H2O, and the EC mean (SD) was 13.5 (9.0) cm H2O (P = 0.49).
  
  
  CONCLUSIONS
  The TE facemask ventilation grip results in improved ventilation over the EC grip in the hands of novice providers.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. ngerstein@gmail.com
authors.forename: Neal Stuart
authors.initials: NS
authors.lastname: Gerstein
authors.forename: Michael Christopher
authors.initials: MC
authors.lastname: Carey
authors.forename: Darren Alan
authors.initials: DA
authors.lastname: Braude
authors.forename: Isaac
authors.initials: I
authors.lastname: Tawil
authors.forename: Timothy Randal
authors.initials: TR
authors.lastname: Petersen
authors.forename: Lev
authors.initials: L
authors.lastname: Deriy
authors.forename: Mark Spencer
authors.initials: MS
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000193:education; D000776:Anesthesiology / Q000193:education; D002983:Clinical Competence; D018592:Cross-Over Studies; D004501:Education, Medical / Q000379:methods; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000379:methods / Q000592:standards; D008297:Male; D008397:Masks; D008875:Middle Aged; D009516:New Mexico; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods / Q000592:standards*