Comparison of Aerosol Generation Between Bag Valve and Chest Compression-Synchronized Ventilation During Simulated Cardiopulmonary Resuscitation

Background: Cardiopulmonary resuscitation can generate aerosols, potentially exposing healthcare workers (HCWs) to infection. Bag valve ventilation (BV) is widely used but is prone to aerosol dispersion, whereas chest compression-synchronized ventilation (CCSV) maintains a closed respiratory circuit. In this study, we compared aerosol generation between CCSV and BV during chest compressions following endotracheal intubation in a simulated resuscitation setting. Methods: In a randomized crossover design, 12 sessions each of CCSV and BV were conducted on an intubated manikin undergoing mechanical chest compressions for 10 min. Aerosols with ≤5-μm diameter were generated using a saline nebulizer and measured every minute with a particle counter positioned 50 cm from the chest compression site. Bayesian linear regression of minute-by-minute log-transformed aerosol particle counts was used to estimate group differences, yielding posterior means, 95% credible intervals, and posterior probabilities. Results: The aerosol particle counts increased during the initial 3 min with the use of both methods. Thereafter, the aerosol particle counts with CCSV stabilized, whereas those with BV continued to increase. From 4 to 10 min, the posterior probability that CCSV generated fewer particles exceeded 0.98, peaking at 9 min. Both peak and time-averaged log-transformed aerosol particle counts were significantly lower with CCSV than with BV (p = 0.010 and p = 0.020, respectively). Conclusions: In this simulation, CCSV generated significantly fewer aerosols than BV did during chest compressions, with differences emerging after 4 min and persisting thereafter. Thus, CCSV may reduce aerosol exposure of HCWs, supporting its early implementation during resuscitation in infectious disease settings.