Positive pressure ventilation coaching during neonatal bag-mask ventilation: A simulation-based pilot study

Delayed cord clamping (DCC) is endorsed by multiple professional organizations for both term and preterm infants. In preterm infants, DCC has been shown to reduce intraventricular hemorrhage, lower incidence of necrotizing enterocolitis, and reduce the need for transfusions. Furthermore, in preterm animal models, ventilation during DCC leads to improved hemodynamics. While providing ventilation and continuous positive airway pressure (CPAP) during DCC may benefit infants, the logistics of performing such a maneuver can be complicated. In this simulation-based study, we sought to explore attitudes of providers along with the safety and ergonomic challenges involved with safely resuscitating a newborn infant while attached to the placenta. Multidisciplinary workshops were held simulating vaginal and Caesarean deliveries, during which providers started positive pressure ventilation and transitioned to holding CPAP on a preterm manikin. Review of videos identified 5 themes of concerns: sterility, equipment, mobility, space and workflow, and communication. In this study, simulation was a key methodology for safe identification of various safety and ergonomic issues related to implementation of ventilation during DCC. Centers interested in implementing DCC with ventilation are encouraged to form multidisciplinary work groups and utilize simulations prior to performing care on infants.

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An Anesthesiologist’s Perspective on the History of Basic Airway Management

Anesthesiology ◽

10.1097/aln.0000000000002646 ◽

2019 ◽

Vol 130 (5) ◽

pp. 686-711 ◽

Cited By ~ 3

Author(s):

Adrian A. Matioc

Keyword(s):

Airway Management ◽

Operating Room ◽

Positive Pressure Ventilation ◽

Face Mask ◽

Intermittent Positive Pressure Ventilation ◽

Positive Pressure ◽

Mask Ventilation ◽

Advanced Airway ◽

History Of ◽

Effective Seal

Abstract This fourth and last installment of my history of basic airway management discusses the current (i.e., “modern”) era of anesthesia and resuscitation, from 1960 to the present. These years were notable for the implementation of intermittent positive pressure ventilation inside and outside the operating room. Basic airway management in cardiopulmonary resuscitation (i.e., expired air ventilation) was de-emphasized, as the “A-B-C” (airway-breathing-circulation) protocol was replaced with the “C-A-B” (circulation-airway-breathing) intervention sequence. Basic airway management in the operating room (i.e., face-mask ventilation) lost its predominant position to advanced airway management, as balanced anesthesia replaced inhalation anesthesia. The one-hand, generic face-mask ventilation technique was inherited from the progressive era. In the new context of providing intermittent positive pressure ventilation, the generic technique generated an underpowered grip with a less effective seal and an unspecified airway maneuver. The significant advancement that had been made in understanding the pathophysiology of upper airway obstruction was thus poorly translated into practice. In contrast to consistent progress in advanced airway management, progress in basic airway techniques and devices stagnated.

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Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0173 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Gil Dinur ◽

Liron Borenstein-Levin ◽

Shachar Vider ◽

Ori Hochwald ◽

Huda Jubran ◽

...

Keyword(s):

Pilot Study ◽

Positive Pressure Ventilation ◽

Neonatal Resuscitation ◽

Random Order ◽

Medical Personnel ◽

Positive Pressure ◽

Mouth Pressure ◽

And Performance ◽

Time Frames ◽

Order Sequence

AbstractObjectivesTo examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation.MethodsA prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped.ResultsAudio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to “positive pressure ventilation” (p<0.01).ConclusionsIn this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.

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