The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Comparison of Ventilation and Cardiac Compressions When Utilizing the Impact Model 730 Automatic Transport Ventilator Versus a Conventional Bag Valve with a Facemask in a Model of Adult Cardiopulmonary Arrest

Nicole Salas, Capt, USAF, NC1; Bernadette Wisor, Capt, USAF, NC1; Janice Agazio, RN, DNSc1; Richard Branson, MS, RRT, FAARC2, Paul Austin, LtCol, USAF, NC1 (1Uniformed Services University of the Health Sciences (USUHS) Graduate School of Nursing; 1335 East West Hwy, Suite 9-700; Silver Spring, MD 20910, 2Dept. of Surgery; University of Cincinnati, Cincinnati, OH)

Background: The Guidelines 2000 for CPR and ECC called for increased use of automatic transport ventilators (ATVs) during CPR. The purpose of this study was to evaluate the delivery of ventilation and compressions during two person CPR on an instrumented manikin by experienced registered nurses (RNs) using a conventional bag valve mask ventilation (BVM) or mask ventilation with an ATV, the Model 730 (Impact Instrumentation, Inc., West Caldwell, NJ), that incorporates a metronome to remind of proper compression timing.

Method: The study was approved by the Institutional Review Board (#TO61EH-01). In a randomized fashion and after an orientation period, 28 RNs alternated performing 4 minutes of CPR using the BVM or Impact 730 to deliver breaths with a mask while the other performed compressions. Volumes were measured using a pneumotach and ease of use was measured using a 10 cm VAS. A one-tailed paired Student’s t-test was used to compare difference in actual and recommended number of breaths, compressions, tidal volume (vol), mask leak, stomach vol; and ease of use (p < or = 0.05).

Results1:

  Diff actual and rec number of breaths in 1 min Diff actual and rec number of compressions in 1 min Diff actual and rec lung tidal vol (ml) Mask leak per breath (ml) Stomach vol per breath (ml) Ease of use score (cm)
Impact 730 0* (0.3) -7.7* (3.2) -120.4 (91.5) 176.1* (98.3) 14.0* (16.8) 8.06* (1.35)
BVM 2.41 (0.8) 11.1 (6.5) -119.8 (187.3) 367.6 (337.7) 137.7 (143.9) 6.46 (2.46)

1Mean (SD), *p < or = 0.05

Conclusion: Subjects tended to provide ventilations and compressions faster than recommended using the BVM. There were no statistical or clinical differences between actual and recommended tidal vol. The reduction in stomach vol per breath with the Impact 730 was likely due to the controlled inspiratory flow resulting in lower peak airway pressure. This reduced stomach vol should decrease the incidence of gastric distention. The reduced mask leak likely resulted from the RN managing the mask with 2 rather than 1 hand and is reflected in the higher ease of use score with the Impact 730. Future studies should avoid inducing bias during the orientation period. Human subject trials are warranted to confirm these findings. This project was supported by a Cooperative Research and Development Agreement between the USUHS and Impact. The views expressed in this abstract are those of the author and do not reflect the official policy or position of the USUHS, USAF, Department of Defense or the US Government.

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