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.