Out‐of‐hospital Ventilation: Bag‐Valve Device vs Transport Ventilator

Abstract

Objective: To examine the patterns of out‐of‐hospital airway management and to compare the efficacy of bag‐valve ventilation with that of the use of a transport ventilator for intubated patients. Methods: A prospective, 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 completed by emergency medical services (EMS) personnel, and arterial blood gas (ABG) samples were obtained within 5 minutes of patient arrival in the ED. The ABG parameters were compared for patients grouped by different airway techniques and presence or absence of cardiac arrest (systolic blood pressure <50 mm Hg) upon ED presentation. Results: Over a one‐year period, 160 surveys were returned. The majority (62%) of the patients were men; the population mean age was 61 ± 19 years. Presenting ABGs were obtained for 76 patients; 17% (13/76) had systemic perfusion and 83% (63/76) were in cardiac arrest. There was no difference in ABG parameters between the intubated cardiac arrest patients ventilated with a transport ventilator (pH 7.17 ± 0.17, Paco2 37 ± 20 torr, and Pao2 257 ± 142 torr) and those ventilated with a bag‐valve device (pH 7.20 ± 0.16, PaCO2 42 ± 21 torr, and Pao2 217 ± 138 torr). The patients ventilated via an esophageal obturator airway (EOA) device had impaired gas exchange, compared with the groups who had endotracheal (ET) intubation (pH 7.09 ± 0.13, Paco2 76 ± 30 torr, and Pao2 75 ± 35 torr). The intubated patients not in cardiac arrest had similar ABG parameters whether ventilated manually with a bag‐valve device or with a transport ventilator. Endotracheal intubation was successfully accomplished in 93% (123/132) of attempted cases. Conclusions: In this sample, ET intubation was the most frequently used airway by EMS providers. When ET intubation was accomplished, adequate ventilation could be achieved using either bag‐valve ventilation or a transport ventilator. Ventilation via the EOA proved inadequate. © 1995 Society for Academic Emergency Medicine