Six-Hour Manual Ventilation with a Bag-Valve-Tube Device by Briefly Trained Non-Medical Personnel is Feasible

Rationale: Manual ventilation with a bag-valve device (BVD) is a Basic Life Support skill. Prolonged manual ventilation may be required in resource-poor locations and in severe disasters such as hurricanes, pandemics, and chemical events. In such circumstances, trained operators may not be available and lay persons may need to be quickly trained to do the job. Objectives: The current study investigated whether minimally trained operators were able to manually ventilate a simulated endotracheally intubated patient for six hours. Methods: Two groups of 10 volunteers, previously unfamiliar with manual ventilation, received brief, structured BVD-tube ventilation training and performed six hours of manual ventilation on an electronic lung simulator. Operator cardiorespiratory variables and perceived effort, as well as the quality of the delivered ventilation, were recorded. Group One ventilated a normal lung (compliance 50cmH2O/L, resistance 5cmH2O/L/min). Group Two ventilated a moderately injured lung (compliance 20cmH2O/L, resistance 20cmH2O/L/min). Results: Volunteers' blood pressure, heart rate (HR), respiratory rate (RR), and peripheral capillary oxygen saturation (SpO2) were stable throughout the study. Perceived effort was minimal. The two groups provided clinically adequate and similar RRs (13.3 [SD = 3.0] and 14.1 [SD = 2.5] breaths/minute, respectively) and minute volume (MV; 7.6 [SD = 2.1] and 7.7 [SD = 1.4] L/minute, respectively). Conclusions: The results indicate that minimally trained persons can effectively perform six hours of manual BVD-tube ventilation of normal and moderately injured lungs, without undue effort. Quality of delivered ventilation was clinically adequate.