Training and educational paperComparison of mouth-to-mouth, mouth-to-mask and mouth-to-face-shield ventilation by lay persons☆
Introduction
Mouth-to-mouth-ventilation (MMV) is the standard technique for ventilation in Basic Life Support. MMV has been proven to be an efficient ventilation method.1, 2, 3 Nevertheless some authors have noted a lack of willingness to ventilate a patient by the mouth-to-mouth technique in witnessed respiratory arrest,4 because of concern about a potential infection.5, 6, 7 Due to these potential risks, rescuers prefer to use a barrier device during ventilation in CPR.3, 4, 8 Safer ventilation techniques for lay rescuer ventilation have been developed to overcome the problems inherent to MMV. Mouth-to-mask and mouth-to-face-shield ventilation techniques (MFV) have been introduced to encourage lay rescuers to perform artificial ventilation; their effectiveness was studied thoroughly.1, 2, 8, 9, 10, 11, 12, 13, 14 Several mouth-to-mask-ventilation devices met the criteria for adequate ventilation.1, 10, 11 On the other hand mouth-to-face shield devices failed to demonstrate the capacity to provide sufficient tidal volume (TV).9 Therefore, the ILCOR 2000 guidelines stated that “the efficacy of face shields has not been documented conclusively”, and suggested that “healthcare professionals and rescuers with a duty to respond should use face shields only as a substitute for mouth-to-mouth breathing and should use mouth-to-mask or bag-mask devices at the first opportunity”.15
So far no prospective study has been carried out on the efficiency of MMV in comparison with mouth-to-mask and MFV, provided by lay persons. Moreover, no data has been published yet, on the time needed to train lay persons sufficiently in these ventilation techniques.
Our study aimed to compare MMV with MPV and MFV, and to assess if a short period of instruction of 10 min would be sufficient to teach lay rescuers the necessary skills for proper ventilation.
Section snippets
Methods
The study was undertaken in a high school in Bruneck, Italy, at 840 m above sea level. Seventy unpaid, voluntary students (28 females, 42 males) participated having given informed, written consent. Mean age was 17.3 ± 0.7 years (range 16–20). Mean height was 178.4 ± 6.1 cm for males and 167.2 ± 6.3 cm for females. No differences in sex or age distribution was observed between the three ventilation groups (P = 0.57 Chi-Square Test). No volunteer had attended any first aid instruction before.
Before the
Results
The results of the three test series with MMV, MPV and MFV regarding TV, MV, PAP, ventilation quality and stomach inflation are given in Table 1. For TV we found overall significant differences between ventilation techniques (P = 0.029, ANOVA) and marginally significant differences for MV (P = 0.061) and PAP (P = 0.058). In TV we found that MFV had significantly lower values in three series than MMV (P = 0.002) and MPV (P = 0.025, ANOVA). Our observed pooled standard deviation (s) of the three test
Discussion
In our study we had to deal with a higher inter-individual variation in TV compared with other studies.1, 9 We suppose that this finding is related to the fact that we used non-medically trained persons in contrast to other studies, where medically trained personnel performed the ventilation tests.1, 9 Moreover, in contrast to other studies,13, 17 we used a bench model with a freely movable head (Figure 1), where candidates had to maintain a patent airway.
In spite of the observed variation we
Limitations
With a mean age of 17 years our study population was younger than in other studies, but the mean TV of 1040 ml achieved was comparable to values obtained by trained persons in other studies (1040 in1 and 1000 in9). All tests were performed on a manikin and may not reflect the situation of real CPR. In real life CPR, bystander rescuers are prone to even higher stress levels. The time between learning a ventilation technique and performing it may be months, or years, rather than hours. Moreover,
Conclusions
We infer from our data that MPV leads to best ventilation quality in bystander CPR. MPV results in a more appropriate TV than MMV and MFV and lower stomach inflation than MMV. The efficiency of ventilation with MFV was not adequate in accordance to previous publications.9 MPV seems to have substantial advantages over MMV: MPV reduces the risk of infection and should lower the barrier for a bystander to perform CPR. Additionally, PAP is moderate, resulting in less stomach inflation than with
Acknowledgements
The authors thank Alfred Niederhofer MPhil, head of the high school Realgymnasium in Bruneck, and all students who participated. We are also indebted to Michael de Zordo and the members of the Mountain Rescue Service, provided by the Alpine Club of Bruneck, for technical and logistic support. Material was provided by the South Tyrolean Mountain Rescue Service.
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2023, American Journal of Emergency MedicineCan high school students teach their peers high quality cardiopulmonary resuscitation (CPR)?
2022, Resuscitation PlusCitation Excerpt :It is important to note that the professional instructors had vast CPR experience, the SIs received a two-day course and the students received a 90-minute course. However, the studies by Sherif, Kim and Paal et al. demonstrate that even short CPR courses may provide sufficient CPR skills.24–26 We do not know the experience of CPR in the student group prior to this study, but we find it reasonable to assume that for the majority it was limited.
Gender aspects in cardiopulmonary resuscitation by schoolchildren: A systematic review
2018, ResuscitationCitation Excerpt :Similarly, Fleischhackl et al. did not find a significant effect on the inflated volume by gender in n = 180 students between 8 and 18 years (p = 0.70) [16] (Table 1). However, in a smaller investigation by Paal et al. with n = 70 students 16–20 years of age (females: n = 42; males: n = 28) male gender was a predictor for higher tidal volume (p = 0.03) [32]. Female students caused a significantly lower percentage of stomach inflation (p = 0.029) [32].
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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2005.03.024.