Neonatal resuscitation 2: an evaluation of manual ventilation devices and face masks

Background: The key to successful neonatal resuscitation is effective ventilation. Little evidence exists to guide clinicians in their choice of manual ventilation device or face mask. The expiratory tidal volume measured at the mask (V-TE(mask)) is a good estimate of the tidal volume delivered during simulated neonatal resuscitation. Aim: To compare the efficacy of (a) the Laerdal infant resuscitator and the Neopuff infant resuscitator, used with (b) round and anatomically shaped masks in a model of neonatal resuscitation. Methods: Thirty four participants gave positive pressure ventilation to a mannequin at specified pressures with each of the four device-mask combinations. Flow, inspiratory tidal volume at the face mask (V-TI(mask)), V-TE(mask), and airway pressure were recorded. Leakage from the mask was calculated from V-TI(mask) and V-TE(mask). Results: A total of 10 780 inflations were recorded and analysed. Peak inspiratory pressure targets were achieved equally with the Laerdal and Neopuff resuscitators. Positive end expiratory pressure was delivered with the Neopuff but not the Laerdal device. Despite similar peak pressures V-TE(mask) widely. Mask leakage was large or each combination of device and mask. There were no differences between the masks. Conclusion: During face mask ventilation of a neonatal resuscitation mannequin, there are large leaks around the face mask. Airway pressure is a poor proxy for volume delivered during positive pressure ventilation through a mask.