Performance of a novel modified bag-valve-mask ventilation technique during manual ventilation and cardiopulmonary resuscitation: a randomized crossover manikin study

The conventional one-handed grip during bag-valve-mask (BVM) ventilation often fails to achieve guideline recommendations. We evaluated a modified BVM ventilation method that allows a single practitioner to compress the bag while maintaining a two-handed mask seal and compared it with the conventional BVM ventilation method in simulated manikin in non-CPR and CPR settings. In a randomized, crossover manikin study, we compared the two methods in two scenarios: Manual Ventilation-No CPR (n = 60) and Manual Ventilation-CPR (n = 56). In each scenario, participants used both BVM methods in a randomized order. The primary outcome was the proportion of ventilations with adequate tidal volume. A ventilation with a tidal volume between 350 to 600 mL was considered adequate. Tidal volume, inspiratory time, and ventilation rate, chest compression quality metrics, chest compression fraction (CCF) were also evaluated. In Manual Ventilation-No CPR scenario, the modified method significantly increased the proportion of adequate ventilations (p < 0.001). In Manual Ventilation-CPR scenario, the modified BVM ventilation method significantly increased the proportion of adequate ventilations (p < 0.001), with a comparable performance in chest compression quality (chest compressions depth, rate and recoil) and no compromise to the CCF. Our simulated manikin study demonstrated that a modified BVM ventilation method improves ventilation performance within an adequate range in both CPR and non-CPR settings. Future studies are warranted to further assess this proposed method.