Improved simulated ventilation with a novel tidal volume and peak inspiratory pressure controlling bag valve mask: A pilot study

Jonathan G Merrell; Adam C Scott; Ryan Stambro; Amit Boukai; Dylan D Cooper

doi:10.1016/j.resplu.2022.100350

Improved simulated ventilation with a novel tidal volume and peak inspiratory pressure controlling bag valve mask: A pilot study

Resusc Plus. 2023 Jan 5:13:100350. doi: 10.1016/j.resplu.2022.100350. eCollection 2023 Mar.

Authors

Jonathan G Merrell^{1

2}, Adam C Scott², Ryan Stambro³, Amit Boukai⁴, Dylan D Cooper^{3

5}

Affiliations

¹ Department of Pediatrics, Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
² Compact Medical Inc, 7711 Ashtree Dr., Indianapolis, IN, USA.
³ The Simulation Center at Fairbanks Hall, Indiana University Health, 340 W Tenth Street, Suite 4100, Indianapolis, IN, USA.
⁴ Department of Emergency Medicine, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL, USA.
⁵ Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract

Introduction: The dangers of hyperventilation during resuscitation are well known. Traditional bag valve mask (BVM) devices rely on end users to control tidal volume (V_t), rate, and peak inspiratory pressures (PIP) of ventilation. The Butterfly BVM (BBVM) is a novel device intending to give greater control over these parameters. The objective of this pilot study was to compare the BBVM against a traditional device in simulated resuscitations.

Methods: Senior emergency medicine residents and fellows participated in a three-phase simulation study. First, participants used the Ambu Spur II BVM in adult and pediatric resuscitations. V_t, PIP, and rate were recorded. Second, participants repeated the resuscitations after a brief introduction to the BBVM. Third, participants were given a longer introduction to the BBVM and were tested on their ability to adjust its various settings.

Results: Nineteen participants were included in the adult arm of the study, and 16 in the pediatric arm. The BBVM restricted V_t delivered to a range of 4-8 ml/kg vs 9 ml/kg and 13 ml/kg (Ambu adult and Ambu pediatric respectively). The BBVM never exceeded target minute ventilations while the Ambu BVMs exceeded target minute ventilation in 2 of 4 tests. The BBVM failed to reliably reach higher PIP targets in one test, while the pediatric Ambu device had 76 failures of excessive PIP compared to 2 failures by the BBVM.

Conclusion: The BBVM exceeded the Ambu Spur II in delivering appropriate V_ts and in keeping PIPs below target maximums to simulated adult and pediatric patients in this pilot study.

Keywords: Ambu; Bag Valve Mask; CPR, Resuscitation; Hyperventilation; Peak Inspiratory Pressure; Pediatric; Tidal volume; Ventilation.