OUT-OF-HOSPITAL VENTILATION - BAG-VALVE DEVICE VS TRANSPORT VENTILATOR

Objective: To examine the patterns of out-of-hospital airway managemen t and to compare the efficacy of bag-valve ventilation with that of th e use of a transport ventilator for intubated patients. Methods: A pro spective, nonrandomized, convenience sample of 160 patients requiring airway management in the out-of-hospital urban setting was analyzed. A survey inquiring about airway and ventilatory management was complete d by emergency medical services (EMS) personnel, and arterial blood ga s (ABG) samples were obtained within 5 minutes of patient arrival in t he ED. The ABG parameters were compared for patients grouped by differ ent airway techniques and presence or absence of cardiac arrest (systo lic blood pressure < 50 mm Hg) upon ED presentation. Results: Over a o ne-year period, 160 surveys were returned. The majority (62%) of the p atients were men; the population mean age was 61 +/- 19 years. Present ing ABGs were obtained for 76 patients; 17% (13/76) had systemic perfu sion and 83% (63/76) were in cardiac arrest. There was no difference i n ABG parameters between the intubated cardiac arrest patients ventila ted with a transport ventilator (pH 7.17 +/- 0.17, Paco(2) 37 +/- 20 t orr, and Pao(2) 257 +/- 142 torr) and those ventilated with a bag-valv e device (pH 7.20 +/- 0.16, Paco(2) 42 +/- 21 torr, and Pao, 217 +/- 1 38 torr). The patients ventilated via an esophageal obturator airway ( EGA) device had impaired gas exchange, compared with the groups who ha d endotracheal (ET) intubation (pH 7.09 +/- 0.13, Paco(2) 76 +/- 30 to rr, and Pao(2) 75 +/- 35 torr). The Intubated patients not in cardiac arrest had similar ABG parameters whether ventilated manually with a b ag-valve device or with a transport ventilator. Endotracheal intubatio n was successfully accomplished in 93% (123/132) of attempted cases. C onclusions: In this sample, ET intubation was the most frequently used airway by EMS providers. When ET intubation was accomplished, adequat e ventilation could be achieved using either bag-valve ventilation or a transport ventilator. Ventilation via the EOA proved inadequate.