title: Human or monitor feedback to improve mask ventilation during simulated neonatal cardiopulmonary resuscitation.
abstract: OBJECTIVE
  To investigate if external chest compressions (ECC) increase mask leak, and if human or technical feedback improves mask ventilation during simulated neonatal cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  In this observational study, 32 participants delivered positive pressure ventilation (PPV) to a modified, leak-free manikin via facemask. Mask leak, tidal volume (VT), positive end expiratory pressure (PEEP) and respiratory rate (RR) were measured with a respiratory function monitor (RFM). Participants had to perform four studies. In the first study, participants performed PPV alone as baseline. Thereafter, three studies were performed in random order. In the PPV+ECC+manometer group, participants had to observe the manometer while the RFM was covered; in the PPV+ECC+RFM group, the RFM was used while the manometer was covered; and in the PPV+ECC+verbal feedback group, the RFM and manometer were covered while a team leader viewed the RFM and provided verbal feedback to the participants.
  
  
  RESULTS
  Median (IQR) mask leak of all studies was 15% (5-47%). Comparing the studies, PPV+ECC+RFM and PPV+ECC+verbal feedback had significantly less mask leak than PPV+ECC+manometer. Mean (SD) VT of all studies was 9.5±3.5 mL. Comparing all studies, PPV+ECC+RFM had a significantly higher VT than PPV and PPV+ECC+manometer. As well, PPV+ECC+verbal feedback had a significantly higher VT than PPV. PEEP and RR were within our target, mean (SD) PEEP was 6±2 cmH2O and RR was 36±13/min.
  
  
  CONCLUSIONS
  During simulated neonatal CPR, ECCs did not influence mask leak, and a RFM and verbal feedback were helpful methods to reduce mask leak and increase VT significantly.
authors.affiliation: Division of Neonatology, Department of Paediatrics, Medical University of Graz, Austria.
authors.forename: Corinna
authors.initials: C
authors.lastname: Binder
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
authors.forename: Megan
authors.initials: M
authors.lastname: O'Reilly
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schwaberger
authors.forename: Berndt
authors.initials: B
authors.lastname: Urlesberger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pichler
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation / Q000379:methods*; D030141:Feedback, Psychological; D005260:Female; D006336:Heart Massage / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008348:Manikins; D008365:Manometry / Q000379:methods*; D008397:Masks; D008991:Monitoring, Physiologic / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D013990:Tidal Volume / Q000502:physiology
keywords: chest compressions; delivery room; infants; neonatal resuscitation; respiratory function monitor