Prehospital Pediatric Ventilation Quality Following Use of a Feedback Device: A Randomized Study

OBJECTIVE Manual ventilation is a lifesaving intervention for children in respiratory arrest, yet the quality of pediatric ventilation delivered by emergency medical services (EMS) clinicians across geographically distinct sites is poorly characterized. We evaluated baseline EMS ventilation performance and whether a ventilation feedback device (VFD) improves adherence to national and international ventilation guidelines for ventilation rate, tidal volume, and mask seal. METHODS We conducted a single-anonymized, randomized, crossover study of EMS clinicians from 5 EMS agencies across 3 metropolitan sites in the United States. Using a simulated 3-year-old toddler manikin, participants completed 2 sequential 2-minute respiratory arrest scenarios separated by a 10-minute washout period. Participants performed ventilation with and without real-time VFD feedback in randomized order. The EOLifeX VFD recorded ventilation rate, tidal volume, and mask leak with each breath. Adherence to age-based guidelines was analyzed using generalized linear mixed-effects models with participants nested within sites. RESULTS We enrolled 123 participants across 5 agencies. With VFD feedback, guideline-recommended tidal volumes were achieved in 87% of breaths compared with 16.2% without feedback. Ventilation rate adherence improved from 65% to 88.6%. Mask leak of less than 30% occurred in 88.4% of ventilations with feedback vs 80% without feedback. CONCLUSION In our simulation study, EMS clinicians rarely met manual ventilation guidelines for pediatric patients in respiratory arrest. The use of a VFD substantially improved guideline adherence, suggesting broad potential to improve ventilation performance.