Performances and limits of Bag-Valve-Device for pre-oxygenation and manual ventilation: A comparative bench and cadaver study.

Introduction: Bag-Valve-Device (BVD) is the most frequently used device for pre-oxygenation and ventilation during cardiopulmonary resuscitation (CPR). A minimal expired fraction of oxygen (FeO ₂ ) above 0.85 is recommended during pre-oxygenation while insufflated volume (VTi) should be reduced during manual ventilation. The objective was to compare the performances of different BVD in simulated conditions.
Methods: Nine BVD were evaluated during pre-oxygenation: spontaneous breathing patients were simulated on a test lung (mild and severe conditions). FeO ₂ was measured with and without positive end-expiratory pressure (PEEP). CO ₂ rebreathing was evaluated. Then, manual ventilation was performed by 36 caregivers (n = 36) from three hospitals on a specific manikin; same procedure was repeated by 3 caregivers (n = 3) on two human cadavers with three of the nine BVD: In non-CPR scenario and during mechanical CPR with Interrupted Chest Compressions strategy (30:2).
Results: Pre-oxygenation: FeO ₂ was lower than 0.85 for three BVD in severe condition and for two BVD in mild condition. FeO ₂ was higher than 0.85 in eight of nine BVD with an additional PEEP valve (PEEP 5 cmH ₂ O). One BVD induced CO ₂ rebreathing. Manual ventilation: For non-CPR manual ventilation, mean VTi was within the predefined lung protective range (4-8 mL/kg PBW) for all BVD on the bench. For CPR manual ventilation, mean VTi was above the range for three BVD on the bench. Similar results were observed on cadavers.
Conclusions: Several BVD did not reach the FeO ₂ required during pre-oxygenation. Manual ventilation was significantly less protective in three BVD. These observations are related to the different BVD working principles.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: FM and DS reports Grants from Fisher and Paykel and travel fees from Air Liquide Medical Systems (ALMS). JCR reports part time salary for research activities (Med(2)Lab) from ALMS and Vygon, and grants from Creative Air Liquide, outside this work. AB and LP are medical engineers in the Med(2)Lab funded by Air Liquide Medical Systems. FB reports personal consulting fees from Löwenstein Medical and ALMS, travel fees from Draeger and ALMS and research support from Covidien and GE Healthcare outside this work. SD received an intermittent stipend from Air Liquide Medical Systems. All other authors declare no competing interests. This study did not receive any grant or financial support.
(Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)