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To intubate or not: ventilation is the question. A manikin-based observational study
  1. Fatimata Seydou Sall1,2,
  2. Alban De Luca1,2,
  3. Lionel Pazart1,
  4. Aurore Pugin1,
  5. Gilles Capellier2,3 and
  6. Abdo Khoury1,2
  1. 1Inserm CIC 1431, University Hospital of Besançon, Besancon, France
  2. 2Department of Emergency Medicine and Critical Care, University Hospital of Besançon, Besançon, France
  3. 3Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Fatimata Seydou Sall; fatimata.sarr{at}


Introduction There is a continuous debate concerning the superiority of endotracheal intubation on bag-valve-mask (BVM) ventilation in patients with cardiac arrest. In this manikin-based observational study, we evaluate and compare the performance of manual ventilation through a facemask (BVM) and an endotracheal tube (ETT).

Methods One hundred and forty healthcare providers were instructed to manually ventilate a manikin as they would do for a 75 kg adult patient in respiratory arrest. Each one was ventilating both through a facemask and an ETT for a 5 min period in a random order. Ventilatory parameters were measured by the ASL 5000 lung simulator and ventilation performance was analysed using a sliding window method published in a previous study to assess accurately ventilation efficiency.

Results The mean ventilation rate was high whatever the technique used (24 bpm). A weak relationship between manual ventilation performance and the type of interface used was observed (p=0.0484). The overall rate of adequate ventilation was low even if we noticed a slight improvement when ventilating through an ETT (13.21% vs 7.5% of adequate ventilation). However, the rate of hyperventilation did not differ between mask and tube (79% vs 77%). A significant relationship is observed between professional category, the size of the hand squeezing the bag and manual ventilation performance (p<0.05).

Conclusion Whatever the interface used, healthcare professionals are still struggling to perform manual ventilation efficiently according to international guidelines. Ventilation with an ETT does not prove to be significantly more efficient than with a facemask. It would be therefore important to recentre the debate on controlling ventilatory parameters with current devices. Focusing on training may maximise manual ventilation efficiency and minimise the loss of time during cardiopulmonary resuscitation.

  • non-invasive ventilation
  • equipment evaluations

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  • Contributors FSS carried out the bibliography, drafted the protocol and the manuscript. ADL defined the new analysis method and realised bench tests. AP performed the statistical analysis and drafted the statistical section. LP participated in the conception and design of the study. GC guided the work and corrected the manuscript. AK supervised the work and corrected the manuscript. All authors approved the final manuscript.

  • Funding This work is supported by an unrestricted grant from the European Commission (FEDER) in Franche-Comté, Bpi France, the Greater Besançon Urban Area Community (CAGB), the Regional Council of Franche-Comté and the General Council of Doubs Department.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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