Evaluation of “Real BVM Help” for Improving Manual Ventilation Quality in the Prehospital Setting: A Before-After Manikin Study

Background: Manual ventilation is a critical skill for emergency medical service (EMS) members. However, it is challenging in terms of correct ventilation rates and tidal volumes, with potentially severe adverse effects of hypo- and hyperventilation. Measuring the quality and involving real-time feedback may be effective in optimizing of manual ventilation. Methods: Data acquired retrospectively from a quality management project in 143 advanced emergency medical technicians were included. They performed bag ventilations on an intubated adult manikin for two minutes without any feedback system, and then another two minutes with the Real BVM Help ® device. Ventilation rates and volumes and their allocation in correct/recommended ranges were determined. Results: With the feedback device, correctly applied ventilation rates increased by 21% (63.6% in the correct range without vs 84.6% with the feedback device; p< 0.001), and ventilation volumes improved by 41% (27% in the correct range without vs 68% with the feedback device; p< 0.001). Without the device, the average ventilation rate was 10.5 ± 3.1/minute, compared to 9.5 ± 1.9/minute with the device. Ventilation volumes amounted to 370.6 ± 84 mL without Real BVM Help ® , while when using it, 415.5 ± 33.1 mL was noted. Conclusion: Our data demonstrate significant improvements in ventilation rates and volumes when using a ventilation feedback device. This manikin study suggests a ventilation feedback device being beneficial for the use by EMS members, but our findings must be further validated in real-life conditions. Plain Language Summary: For various emergency situations in the out-of-hospital setting, it is important for ambulance personnel to be able to perform manual ventilations using a ventilation bag on patients. This critical skill is, however, difficult to acquire and maintain. Ventilating too little or too much are common challenges. Thus, measuring (with a so-called "feedback device") how much air is given and how many times per minute may support paramedics. We thus conducted a data analysis of paramedics ventilating manikins with and without a feedback device, and we observed the allocation in correct/recommended ranges. Correctly applied ventilations increased significantly with the use of a feedback device. Our data thus suggests a ventilation feedback device being beneficial for the use by paramedics, but our findings must be further validated with real patients instead of manikins.