Comparison of two mask holding techniques for two person bag-valve-mask ventilation: A cross-over simulation study

Abstract

Purpose: Two-person bag-valve-mask (BVM) ventilation can provide a better seal and more effective ventilation. It is known that a mask holding technique using thenar eminence of both hands (Thenar technique) could results in less fatigue and be more comfortable than two-hand E-C technique for prolonged ventilation. However, evidence to support this hypothesis is limited. This study compared the fatigue of hands and ventilation parameters in two person BVM ventilation using two mask holding techniques. Materials and methods: The hospital providers who do not frequently use BVM in their practice were enrolled in the study. They all performed BVM holding on RespiTrainer™ for 5 min using both techniques 1 week apart after being randomized. An anesthesia ventilator substituted for bagging to unify the delivered volume. The pinch and grip power of both hands before and after the holding using each technique, average tidal volume (TV) and peak airway pressure (PAP) for 5 min were compared between groups using ANCOVA. Results: Twenty-one doctors and seven nurses participated in the study. The pinch power of both hands in E-C technique was significantly decreased after 5 min compared to Thenar technique (7.65 ± 1.83 kg vs. 8.37 ± 1.99 kg in left; 8.07 ± 2.00 kg vs. 8.56 ± 2.15 kg in right; p < 0.05, respectively). There were no differences in the grip powers of both hands between E-C and Thenar techniques (32.55 ± 9.65 kg vs. 31.96 ± 9.56 kg in left, 34.21 ± 10.35 kg vs. 33.32 ± 9.65 kg in right). The TV (E-C 554.1 ± 6.56 ml vs. Thenar 554.1 ± 6.26 ml) and PAP (E-C 12.93 ± 0.23 cmH2O vs. Thenar 12.98 ± 0.19 cmH2O) were not different. Conclusion: The E-C technique may induce more fatigue in the intrinsic muscles of the first web space of hands compared to the Thenar technique during 5 minutes of two person BVM ventilation. However, there was no significant difference in grip power loss and ventilation quantity between the two techniques.