Short communicationMouth-to-mouth ventilation is superior to mouth-to-pocket mask and bag-valve-mask ventilation during lifeguard CPR: A randomized study☆
Introduction
Administration of ventilations plays an important role in cardiopulmonary resuscitation (CPR), especially in asphyxial cardiac arrests.1 The European Resuscitation Council recommends a ventilation duration of one second to achieve chest rise and effective ventilation. Likewise, reduction of interruptions in chest compressions (no-flow time) is crucial for maintaining coronary and cerebral perfusion.2, 3 Consequently, survival increases and neurological injuries following cardiac arrest can be reduced.4, 5, 6 Previous studies have compared the ability of different ventilation techniques to deliver the recommended tidal volume7 and inspiratory rates.8 Except from over-ventilation resulting in gastric inflation and potential secondary lung injury, these variables are of unknown clinical importance.9 No previous studies have compared the effect of ventilation techniques on no-flow time. Lay rescuers are recommended to use mouth-to-mouth ventilation (MMV),2 while healthcare professionals provide bag-valve-mask ventilation (BMV) during CPR.10 Mouth-to-pocket mask ventilation (MPV) is an effective alternative.2 In the resuscitation of a drowning victim, lifeguards are recommended to use MPV.11 However, this recommendation is not evidence-based. The objective of this study was to compare the effect of MMV, MPV and BMV on CPR quality among surf lifeguards.
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Participant recruitment and ethics
Eligible participants were professional, paid surf lifeguards in active service (seasonal: May–August) aged 18 or above. Participants were recruited from two Danish lifeguard organisations. All surf lifeguards complete annual mandatory CPR re-training before commencing active service. Demographic data on age, sex, certification year, surf lifeguard experience, occupation and preferred ventilation technique were collected (Table 1).
Study participation was voluntary and oral and written consent
Results
A total of 63 surf lifeguards were invited to participate in the study of which two declined to participate. Of the 61 randomized individuals, one was excluded due to nightfall, as it was impossible to complete video recordings. Demographic information is shown in Table 1 (mean age: 25.4 years, male: 67% and female: 33%).
Results from single-rescuer scenarios are shown in Fig. 2. Overall, no-flow time significantly differed between the three groups (MMV: 8.9 ± 1.6 s, MPV: 10.7 ± 3.0 s and BMV: 12.5 ± 3.5
Discussion
In this randomized study, we found that MMV significantly reduces interruptions in CPR and produces a higher proportion of effective ventilations compared to MPV and BMV. When MPV and BMV were used, there was a mean delay in starting compressions of 1.8 s and 3.6 s in each cycle compared to MMV (MMV 8.9 s, MPV 10.7 s and BMV 12.5 s). In Denmark, surf lifeguards often work on beaches far from EMS. Assuming 20 min of lifeguard CPR before arrival of the EMS at the beach and a compression–ventilation
Conclusion
This study is the first to demonstrate that MMV is superior to MPV and BMV during simulated single-rescuer CPR, as it reduces the no-flow time and results in more effective ventilations. Our results suggest that compared to MPV and BMV, CPR quality is improved using MMV.
Conflict of interest
None of the authors have conflicts of interest to declare.
Acknowledgements
We sincerely thank Chief lifeguard of the North Zealand Surf Lifeguard Service, John Mogensen and Chief of the Surf Lifeguard Service at Amager Beach Park and Svanemølle Beach, Steve Martinussen for excellent collaboration. We are greatly indebted to all the surf lifeguards who volunteered to participate in the study.
Funding: The study was supported by the Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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2016, American Journal of Emergency MedicineEuropean Resuscitation Council Guidelines for Resuscitation 2015. Section 2. Adult basic life support and automated external defibrillation.
2015, ResuscitationCitation Excerpt :If a barrier device is used, care should be taken to avoid unnecessary interruptions in CPR. Manikin studies indicate that the quality of CPR is superior when a pocket mask is used compared to a bag-valve mask or simple face shield.260–262 Foreign body airway obstruction (FBAO) is an uncommon but potentially treatable cause of accidental death.263
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.01.009.