Presentation on theme: "Ventilation techniques used by lifeguards Bo Løfgren, MD, PhD Honorary Associate Professor in Resuscitation and Emergency Medicine Department of Internal."— Presentation transcript:
Ventilation techniques used by lifeguards Bo Løfgren, MD, PhD Honorary Associate Professor in Resuscitation and Emergency Medicine Department of Internal Medicine and Clinical Research Unit Regional Hospital of Randers, Randers, Denmark & Research Center for Emergency Medicine Institute of Clinical Medicine Aarhus University Hospital, Aarhus, Denmark HLR2014 Conference Tylösand, Sweden | June 3-4 | Drowning
Conflict of interest None to disclose
Resuscitation in drowning Differs from primary cardiac arrest Ventilation is a priority Supplemental oxygen
PICO: Which ventilation technique? Among adults and pediatric drowning victims (P), does delivery of ventilation with another specific ventilation technique (I), compared with mouth-to-mouth ventilation (C), change survival with favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC, hands-off time (O)? No clinical studies Outcome measure
Critical CPR skills for lifesavers The first and most important treatment of the drowning victim is provision of immediate mouth-to-mouth ventilation. (…) encourages that airway adjunct methods, such as mouth-to- mask, be taught to lifesavers and used as appropriate. (…) encourages the training and equipping of lifesavers with oxygen.
The use of oxygen by lifesavers (…) recommend a non-rebreathing mask with a fixed flow of 15 litres of oxygen per minute for spontaneously breathing victims and a transparent mask with oxygen inlet for patients in ventilatory arrest.
Which ventilation technique? Mouth-to-pocket mask ventilation (MPV) Bag-mask ventilation (BMV) Mouth-to-mouth ventilation (MMV) Allow supplementation of oxygen
Aim To compare different ventilation techniques on the quality of CPR
Primary outcome measure Interruptions in chest compressions
Methods Professional, surf lifeguards (> 18 years) Recruited from two Lifeguard Services Annual mandatory CPR re-training Oral and written consent obtained Performance not disclosed Questionnaire – demographics
Study design Randomized – single rescuer CPR – manikin MMV, MPV (PocketMask TM ), BMV (theBAG II TM ) Allowed to familiarize with the equipment 3 min. CPR 5 min. rest 3 min. CPR 5 min. rest 3 min. CPR 5 min. rest Data collected on the beach (laptop/video)
Demographics Mean age SD (years) 25.4 5.9 Sex (n, %) Female Male 20 (33%) 40 (67%) Certification year (mean SD)2006 4.4 Years of experience (mean SD)4.4 4.4 Health care professional (n, %)7 (13 %)
CPR quality 8.9 1.6 s10.7 3.0 s12.5 3.5 s ** † Data are mean SD. *P<0.001 compared to MMV. †P<0.001 compared to MPV.
Chest compressions 112 13 min -1 110 13 min -1 112 14 min -1 32.1 8.9 mm31.7 8.7 mm31.5 9.0 mm
Another benefit from measuring … 32.1 8.9 mm31.7 8.7 mm31.5 9.0 mm Data are mean SD. ERC 2005 ERC 2010
Ventilations *P<0.001 compared to MMV and MPV respectively 0.7 0.2 s 0.5 0.2 s * * 0.6 0.2 L0.6 0.3 s0.4 0.2 L *P<0.001 compared to MMV and MPV respectively
Effective ventilations MMVMPVBMV 91 % (n=515) 79 % (n = 518) 59 % (n=557) * p 0.001, MMV vs MPV, MMV vs BMV and MPV vs BMV * * *
Conclusion Mouth-to-mouth ventilation reduces interrup- tions in chest compressions and produces a higher number of effective ventilations when compared to mouth-to-mask and bag-mask ventilation during lifeguard CPR
Mouth-to-mouth by lifeguards? Reluctance Body fluids e.g. vomit, blood etc. Communicable disease
Aim To compare mouth-to-pocket mask and mouth-to-face shield ventilation on the quality of CPR
Study design 30 volunteer surf lifeguards (age 25 y; F 9/30) Oral and written consent obtained Formally trained in MPV and MFV Randomized – single rescuer CPR w MPV/MFV Data from manikin & video recordings Quality of CPR: interruptions in chest comp
Conclusion Mouth-to-face-shield ventilation increases interruptions in chest compressions reduces the proportion of effective ventilations and decreases delivered tidal volumes when compared with mouth-to-pocket mask ventilation.
General study limitations Manikin study No body fluids e.g. vomit, blood etc. Single rescuer scenario No physical exertion
Future directions More studies on ventilation techniques Multiple rescuers/team effort Supraglottic airway devices (SGA) Single rescuer over the head-CPR Clinical data needed
Acknowledgement John Mogensen, North Zealand Lifeguard Service Steve Martinussen, Copenhagen Lifeguard Service Carsten Jørgensen, Aalborg Lifeguard Service All the surf lifeguards participating in the studies Financial support Research Award from The Christenson-Ceson Family Foundation Aarhus University Hospital and Regional Hospital of Randers HLR2014 Conference Tylösand, Sweden | June 3-4 | Drowning
Further information - collaboration Bo Løfgren, MD, PhD firstname.lastname@example.org