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Comparison of four techniques on facility of two-hand Bag-valve-mask (BVM) ventilation: E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (non-dominant hand) and Thenar Eminence (non-dominant hand) – E-C (dominant hand)

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ABSTRACT

Introduction:: Bag-valve-mask (BVM) ventilation is the first and important part of the airway management. The aim of present study was to evaluate the quality of four different BVM ventilation techniques – E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (Non dominant hand), and Thenar Eminence (Non dominant hand)-E-C (Dominant hand) – among two novice and experienced groups.

Methods:: In a case-control and mannequin based study that was conducted in Tabriz University of medical sciences, 120 volunteers were recruited and divided into two groups. 60 participants in experienced and other 60 as novice group who observed BVM ventilation but hadn’t practical experience about BVM ventilation. Every participant in both groups performed 4 BVM ventilation techniques under the supervision of an experienced assessor. Quality of mannequin chest expansion was recorded by two other experienced assessors who were blind to ventilation process. The data were analyzed with SPSS 17.0.

Results:: In novice group, when evaluating each technique performance, they did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique much better than the others (P<0.0001). But in the experienced group, there was no meaningful difference between the all four techniques (P= 0.102).

Conclusion:: Novice participants did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique better than the others. Therefore, it is recommended that training of this technique was placed in educational program of medical students.

No MeSH data available.


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Mentions: Bag-valve-mask (BVM) ventilation is one of the major principals of maintaining airway in different medicalscenarios.1-4 Although, BVM ventilation seems to be easy to perform, its proper application could be challenging,especially with less experienced medical staff. In the most broadly used technique, E-C clamp technique,the applicant holds and fixed the mask on the face using one hand and ventilation is achieved through pressingthe bag with the other hand (Figure 1). Usually, in order to reach therequired ventilation, the applicant performs simultaneous jaw thrust using the third, fourth and fifth fingers(resembling E letter) while vertical pressure is applied on the mask using thumb and index fingers (resemblingC letter). Despite being extremely advantageous in resource-limited settings, the staff using this method needs tobe experienced unless the required mask fitting on the face would not be achieved and consequently, theventilation would not be secured. Alternatively, Thenar Eminence technique could be used in which isapplied bimanually and therefore another person is required to push the bag(Figure 2).4-10 Having more than 55 years old age, male gender, body mass index (BMI)> 31 kg/m2, anesthesia provider, obstructive sleep apnea (OSA), moustache, a short neck, history of neck radiation, short thyromental distance, Mallampati score of 3 and 4 are mentioned as risk factors of difficult BVM ventilation.7 Golzari et al showed that placing folded sterile gas in buccal cavities in toothless patient scan remarkably improve BVM ventilation when compared to those toothless individuals with or without denture.2 In the present study, we compared the efficacy of two new combined techniques with these two conventionalmethods in two groups of the experienced and novice staff on mannequin. In new combined techniques,the participant used E-C technique with one hand and simultaneously Thenar Eminence technique withthe other hand (Figure 3). Later, the participant switchedthe techniques and hands. Through analysis of obtained results, it was tried to choose thesimplest way of BVM ventilation for novice practitioners.


Comparison of four techniques on facility of two-hand Bag-valve-mask (BVM) ventilation: E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (non-dominant hand) and Thenar Eminence (non-dominant hand) – E-C (dominant hand)
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304096&req=5

Mentions: Bag-valve-mask (BVM) ventilation is one of the major principals of maintaining airway in different medicalscenarios.1-4 Although, BVM ventilation seems to be easy to perform, its proper application could be challenging,especially with less experienced medical staff. In the most broadly used technique, E-C clamp technique,the applicant holds and fixed the mask on the face using one hand and ventilation is achieved through pressingthe bag with the other hand (Figure 1). Usually, in order to reach therequired ventilation, the applicant performs simultaneous jaw thrust using the third, fourth and fifth fingers(resembling E letter) while vertical pressure is applied on the mask using thumb and index fingers (resemblingC letter). Despite being extremely advantageous in resource-limited settings, the staff using this method needs tobe experienced unless the required mask fitting on the face would not be achieved and consequently, theventilation would not be secured. Alternatively, Thenar Eminence technique could be used in which isapplied bimanually and therefore another person is required to push the bag(Figure 2).4-10 Having more than 55 years old age, male gender, body mass index (BMI)> 31 kg/m2, anesthesia provider, obstructive sleep apnea (OSA), moustache, a short neck, history of neck radiation, short thyromental distance, Mallampati score of 3 and 4 are mentioned as risk factors of difficult BVM ventilation.7 Golzari et al showed that placing folded sterile gas in buccal cavities in toothless patient scan remarkably improve BVM ventilation when compared to those toothless individuals with or without denture.2 In the present study, we compared the efficacy of two new combined techniques with these two conventionalmethods in two groups of the experienced and novice staff on mannequin. In new combined techniques,the participant used E-C technique with one hand and simultaneously Thenar Eminence technique withthe other hand (Figure 3). Later, the participant switchedthe techniques and hands. Through analysis of obtained results, it was tried to choose thesimplest way of BVM ventilation for novice practitioners.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction:: Bag-valve-mask (BVM) ventilation is the first and important part of the airway management. The aim of present study was to evaluate the quality of four different BVM ventilation techniques – E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (Non dominant hand), and Thenar Eminence (Non dominant hand)-E-C (Dominant hand) – among two novice and experienced groups.

Methods:: In a case-control and mannequin based study that was conducted in Tabriz University of medical sciences, 120 volunteers were recruited and divided into two groups. 60 participants in experienced and other 60 as novice group who observed BVM ventilation but hadn’t practical experience about BVM ventilation. Every participant in both groups performed 4 BVM ventilation techniques under the supervision of an experienced assessor. Quality of mannequin chest expansion was recorded by two other experienced assessors who were blind to ventilation process. The data were analyzed with SPSS 17.0.

Results:: In novice group, when evaluating each technique performance, they did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique much better than the others (P<0.0001). But in the experienced group, there was no meaningful difference between the all four techniques (P= 0.102).

Conclusion:: Novice participants did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique better than the others. Therefore, it is recommended that training of this technique was placed in educational program of medical students.

No MeSH data available.