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)

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.

Comparison of Three Techniques on Facility of Bag-Mask Ventilation: Thenar Eminence, E-O and E-C

“…Moreover, Mayo et al ( 19 ), pointed out using the computer-controlled patient simulator to train basic measurements of airway control to intern students would be adequately beneficial. Furthermore, based on the other study, we examined the facility 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 inexperienced and skilled groups and we conclude inexperienced participants did thenar eminence (non-dominant hand) - E-C (dominant hand) technique better than the others and this technique is suggested for training of medical students, also ( 20 ). The present study is in agreement with the Umseh et al ( 3 ) study in its prioritizing E-O over E-C and thenar eminence technique.…”

Facemask ventilation and vocal cord angle following neuromuscular blockade: a prospective observational study#

“…After loss of eyelash reflex, an oropharyngeal airway (size 8 for women or 9 for men) was inserted. Subsequently, one anaesthetist (MK) applied the facemask with a two‐hand ‘E‐C' technique [14], and the patient's head was gently extended. At the same time, another anaesthetist (KN) inserted a flexible bronchoscope (Olympus LF‐GP, Olympus Corp., Tokyo, Japan) through a custom‐made self‐sealing diaphragm attached to the elbow connector of the breathing circuit (online Supporting Information, Figure S1).…”

Management of the Difficult Airway

“…Holding a mask seal with a thenar approach compared with the E-C technique may also improve ventilation as shown in Figure 1. Similarly, when personnel resources allow, a 2-provider masking technique can improve ventilation 51–53 . If abdominal distension is contributing to difficulty delivering assisted breaths, gastric decompression can help facilitate diaphragmatic excursion, provided that decompression attempts do not interfere with other airway management efforts.…”