Face mask ventilation: A comparison of three techniques

Background: There are multiple techniques for face-mask (FM) ventilation. To our knowledge, the one-handed vs. two-handed C-E technique has been compared in children and adults, but no studies have compared the various two-handed methods. Objective: To compare the effectiveness of mask seal using three different FM techniques on a model intended to simulate difficult FM ventilation and measure ventilation performance. Methods: This was a prospective randomized study of health care providers. A standard airway-training mannequin was modified to produce variable airway resistance and allow measurements of ventilation volume and pressure. Each subject performed FM ventilation for 3 min per technique (30 breaths) in a randomized order. Median exhaled tidal volume and proximal peak flow pressure were determined and compared. Results: Seventy subjects were enrolled. Both two-handed ventilation techniques were more effective than the one-handed technique by both volume and pressure measurements. The one-handed C-E technique yielded a median volume of 428.4 mL, vs. the two-handed C-E technique with 550.8 mL, and the two-handed V-E technique with 538 mL (p < 0.001). Peak pressure measurements revealed a median of 54.6 cm H₂O for the one-handed C-E technique, 66 cm H₂O for the two-handed C-E technique, and 66.6 cm H₂O for the two-handed V-E technique (p < 0.001). There was not a difference between the various two-handed techniques. Conclusions: This model for FM ventilation is able to differentiate the efficacy of FM techniques. Both two-handed ventilation methods were superior to one-handed ventilation, both of which should perhaps be included in airway training for health care providers.