489 - Two hands are better than one: Delivering Positive Pressure Ventilation in a Neonatal Manikin Model

Poster Number: 489
Publication Number: 489.231

Anne Murray, University College Cork, Cork, Cork, Ireland; Tom Beechinor, University College Cork, Cork, Cork, Ireland; Vicki Livingstone, University College Cork, Cork, Cork, Ireland; Eugene Dempsey, University Colleeg Cork, Cork, Cork, Ireland

Background: Approximately 10% of newly born infants require some form of assistance to establish regular breathing at birth. International guidelines advise the use of positive pressure ventilation (PPV) in newly born infants with bradycardia or inadequate respiratory effort. Previous studies investigating mask leak in modified newborn manikin models have shown high levels of mask leak (up to 65%), even in participants with many years experience. Tracey et al (2010) found a significant reduction in mask leak with a two-handed technique compared to one-handed technique, however Wilson et al (2014) found contrary evidence, with no difference in mask leak between one-handed, two-handed or the spider hold techniques.

Objective: Primary aim: To determine if there is a difference in mask leak between one-handed (OH) and two-handed (TH) hold of the facemask when delivering PPV during neonatal resuscitation. Secondary aims: To determine if the following affects the percentage of mask leak: • Level of experience • Professional group

Design/Methods: A crossover randomized trial was performed. All participants had completed their Neonatal Resuscitation Programme training with a certified provider. The study was carried out using The Neopuff Infant Resuscitator used with a size 42mm Fisher & Paykel facemask and premature neonatal manikin. A Respironics Respiratory Function monitor (RFM) was used to measure inflation pressures, tidal volumes, and expiratory leak via a flow sensor between the mask and the Neopuff. Two minutes of breaths were recorded for each participant for both OH and TH techniques. For TH technique, the participants performed the mask hold, while one of two researchers delivered breaths. Participants were randomly assigned to perform OH or TH technique first. The median mask leak during the second minute of each session for each participant was calculated and used in the analysis.

Results: There were 41 participants with one excluded from the analysis due to missing data. A total of 1350 breaths were analysed. Median mask leak was greater with one-handed (median(IQR): 12.3%(5.5% to 49.1%)) compared with two-handed (median(IQR): 5.2%(2.6% to 14.6%)) technique (p=0.041). There were no significant relationships between years of experience or professional group with one-handed or two-handed leak values.Conclusion(s): When using positive pressure ventilation in a neonatal manikin, two-handed technique is superior to one-handed technique in reducing mask leak. Further clinical trials of one-handed versus two-handed technique are required.