Smaller tidal volumes during cardiopulmonary resuscitation: comparison of adult and paediatric self-inflatable bags with three different ventilatory devices

Gastric inflation and subsequent regurgitation of stomach contents is a maj or hazard of bag-valve-face mask ventilation during the basic life support phase of cardiopulmonary resuscitation (CPR). Recent investigations suggest ed that use of a paediatric self-inflating bag may reduce stomach inflation while ensuring sufficient lung ventilation. The purpose of our study was t o examine whether use of a paediatric self-inflating bag in association wit h laryngeal mask airway, combitube, and bag-valve-face mask may provide ade quate lung ventilation, while reducing the risk of gastric inflation in a b ench model simulating the initial phase of CPR. Sixteen intensive care unit registered nurses volunteered for our study. Use of a paediatric versus ad ult self-inflating bag resulted in a significantly (P < 0.01) lower mean (/-S.D.) tidal lung volume with both the laryngeal mask airway and combitube (laryngeal mask airway 349 +/- 149 ml versus 725 +/- 266 ml, combitube 389 +/- 113 ml versus 1061 +/- 451 ml). Lung tidal volumes were below the Euro pean Resuscitation Council recommendation with both self-inflatable bags in the bag-valve-face mask group (paediatric versus adult self-inflatable bag 256 +/- 77 ml versus 334 +/- 125 ml). Esophageal tidal volumes were signif icantly (P < 0.05) lower using the paediatric self-inflatable bag in the ba g-valve-face mask group; almost no gastric inflation occurred with the lary ngeal mask airway, and none with the combitube. In conclusion, use of the p aediatric self-inflating bag may reduce gastric inflation, but measured lun g tidal volumes are below the European Resuscitation Council recommendation when used with either, the laryngeal mask airway, combitube, or bag-valve- face mask. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.