A comparison of two-handed versus single-handed bag valve mask ventilation during two-rescuer CPR on a simulation manikin

Abstract

Background: During cardiopulmonary resuscitation (CPR), using two hands to create a mask-face seal has been shown to be superior to using one hand. Current CPR guidelines advocate that when there are only two rescuers present, one rescuer should perform BVM ventilation by creating a mask-face seal with one hand while using the other hand to compress the BVM resuscitator bag. Methods: In this simulation manikin based experimental study, 40 CPR trained participants compared standard two-rescuer CPR using a one-handed mask-face seal to a modified method of two-rescuer CPR where one rescuer performed a mask-face seal using both hands while the second rescuer performed chest compressions and also squeezed the BVM resuscitator bag twice during every ventilatory pause. Results: The mean delivered volume for the standard two-rescuer CPR (one-handed mask-face seal) and modified two-rescuer CPR (two-handed mask-face seal) methods were 190.2±50.5 ml and 319.4±71.4 ml respectively (p<0.0001). There were no statistically significant differences between the two methods regarding the a) mean compression rate (118.08 ± 9.67 vs 117.05 ± 10.99 compressions/min; p=0.477), b) mean compression depth (52.77 ± 6.77 mm vs 52.80 ± 5.57 mm; p=0.980), c)ventilatory pause time (4.56 ± 0.43 vs 4.62 ± 0.64 seconds; p=0.288), d) chest compression fraction (76.57 ± 2.57 vs 75.92 ± 2.14; p=0.186) and e) Borg scale for perceived exertion scores (12.51 ± 1.69 vs 13.05 ± 2.02; p=0.174). Conclusions: With the modified technique, participants were able to deliver higher volumes of rescue breaths without compromising the quality of chest compressions.