Mask leak increases and minute ventilation decreases when chest compressions are added to bag ventilation in a neonatal manikin model.
OBJECTIVE
To determine changes in respiratory mechanics when chest compressions are added to mask ventilation, as recommended by the International Liaison Committee on Resuscitation (ILCOR) guidelines for newborn infants.


METHODS
Using a Laerdal Advanced Life Support leak-free baby manikin and a 240-mL self-inflating bag, 58 neonatal staff members were randomly paired to provide mask ventilation, followed by mask ventilation with chest compressions with a 1:3 ratio, for two minutes each. A Florian respiratory function monitor was used to measure respiratory mechanics, including mask leak.


RESULTS
The addition of chest compressions to mask ventilation led to a significant reduction in inflation rate, from 63.9 to 32.9 breaths per minute (p < 0.0001), mean airway pressure reduced from 7.6 to 4.9 cm H2 O (p < 0.001), minute ventilation reduced from 770 to 451 mL/kg/min (p < 0.0001), and there was a significant increase in paired mask leak of 6.8% (p < 0.0001).


CONCLUSIONS
Adding chest compressions to mask ventilation, in accordance with the ILCOR guidelines, in a manikin model is associated with a significant reduction in delivered ventilation and increase in mask leak. If similar findings occur in human infants needing an escalation in resuscitation, there is a potential risk of either delay in recovery or inadequate response to resuscitation.
Neonatal Intensive Care Unit, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
Mark B
MB
Tracy
Dharmesh
D
Shah
Murray
M
Hinder
Jan
J
Klimek
James
J
Marceau
Audrey
A
Wright
D006336:Heart Massage; D006801:Humans; D007231:Infant, Newborn; D008348:Manikins; D008397:Masks; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000295:instrumentation* / Q000379:methods
International Liaison Committee on Resuscitation guidelines; Mask leak; Mask ventilation; Neonatal resuscitation