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Airway management by first responders when using a bag-valve device and two oxygen-driven resuscitators in 104 patients

Published online by Cambridge University Press:  23 December 2004

G. J. Noordergraaf ,
P. J. van Dun ,
B. P. Kramer ,
M. P. Schors ,
H. P. Hornman ,
W. de Jong  and
A. Noordergraaf
G. J. Noordergraaf
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
P. J. van Dun
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
B. P. Kramer
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
M. P. Schors
Affiliation:
St. Elisabeth Hospital, Department of Anaesthesiology, Tilburg, The Netherlands
H. P. Hornman
Affiliation:
Fire Department, City of Tilburg, Tilburg, The Netherlands
W. de Jong
Affiliation:
St. Elisabeth Hospital, Department of Clinical Physics, EN Tilburg, The Netherlands
A. Noordergraaf
Affiliation:
University of Pennsylvania, Departments of Bioengineering and Anaesthesiology, PA, USA
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Abstract

Summary

Background and objective: To evaluate the capability of first responders to ensure an airway and ventilate the lungs of a patient employing a bag-valve device and two oxygen-driven resuscitators.

Methods: Prospective, controlled, blinded, single-centre clinical trial using a bag-valve device and one of two FR-300® devices, with 20 cmH2O working pressure, flows of 24 and 30 L min−1. One-hundred-and-four patients were analysed. Induction of anaesthesia was followed by ventilation of the lungs with a bag-valve device and an Oxylator® (CPR Medical Devices Corp., Markham, Ontario, Canada) in manual and automatic modes. Each series was repeated twice by a fireman first responder using a hand-held mask to seal the airway, once under anaesthesia and then again under anaesthesia with muscle relaxation.

Results: Patients’ mean age 49 ± 17 yr; 47% male, 48–132 kg. Only 29% had optimal facial and airway physiognomy. Airway management was significantly poorer when the bag-valve device was used than with either Oxylator® mode (P < 0.0001); 23% of cases were not manageable with the bag-valve device. Gastric insufflation was markedly less with the Oxylator® (P < 0.02).

Conclusions: The use of an oxygen-driven device improves the ability of first responders to secure an airway and reduce gastric insufflation, even when distracted. Oxylators® perform significantly better (P < 0.0001) than the bag-valve device.

Keywords

EQUIPMENT AND SUPPLIES, ventilators, mechanicalEMERGENCY TREATMENT, respiration artificial, first aidHEALTHCARE QUALITY ASSESSMENT AND EVALUATION, technology assessment, biomedical
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 5 , May 2004 , pp. 361 - 366
Copyright
2004 European Society of Anaesthesiology

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