Evaluation the quality of Bag-Mask Ventilation by E/C, T/E and Hook technique (a new proposed technique)

Abstract

Background: Bag-Mask Ventilation (BMV) is a life-saving component in managing emergency airway requirements and induction of general anesthesia. It’s one of the essential skills that every physician should know how to do it properly. There are several techniques for doing BMV. In this study we aimed to compare the quality of ventilation by the E/C and thenar eminence (T/E) techniques and hook technique to suggest the best possible way for doing BMV by single person. Method: first, a pilot study was done on manikins by 63 medical staff using hook method ventilation to evaluate its efficacy. Then, after the approval of the university ethics committee and obtaining the consent of the patient's guardians, the study was performed on 492 patients who admitted emergency department and were randomly divided into three groups and each group was ventilated by one technique. Patients in need of a reliable airway with an indication for rapid sequence intubation were included in the study. Patients were ventilated by a bag-mask attached to a capnograph by an operator, and ET Co2 was recorded. All demographic data were collected and analyzed by SPSS software version 22. The success rate was reported as frequency (percentage) as well as mean ± standard deviation. Result: In comparison with PCO2 results obtained from capnography between T/E, E/C and hook techniques, the successful ventilation rate was 87.2% in the T/E method, 89.6% in E/C technique and 93.3% in the hook method. The success rate of ventilation with the hook method was considerably higher than two other methods. There was a significant difference in ventilation rate between three methods (Pv= 0.038). In the comparison between groups, the trend of PCO2 changes in different measurements was statistically significant (pv=0.006). Also, the within-group comparison of PCO2 changes in different measurements was statistically significant (P<0/001). Conclusion: our study concluded that the success rate of ventilation with the hook method was considerably higher than the T/E and E/C methods. The results expressed that due to the chin lift maneuver while the mask is fixed on the face, for resuscitators with small hands and for long-term use without fatigue and finger pain, this method can be suggested as a new Bag-Mask Ventilation method. This study leads to the development of a new method for bad-mask ventilation called the hook method. Trial registration: IRCT registration number: IRCT20121010011067N5 URL of trial registry record: https://www.irct.ir/trial/57420 Date of trial registration: 2021-07-17. Full date of the first registration: 2021-08-11.