Hook technique novel bag-mask ventilation technique good for prolonged use without fatigue

Hassan Soleimanpour, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, and colleagues aimed to compare the quality of ventilation achieved using the Thenar Eminence (T/E) technique, the E/C technique and a novel approach known as the hook technique that involves a chin lift manoeuvre while securely fitting the mask. Their goal was to identify the most effective single-person BMV method.

The study, published in BMC Anesthesiology, found that the hook method achieved a notably higher success rate in ventilation compared to the E/C and T/E methods. This implies that the hook method could serve as a novel BMV technique, particularly for resuscitation with small hands for prolonged use without finger discomfort and fatigue.

"The success rate of bag-mask ventilation by hook method in manikins was 93.7%," the researchers reported. "In the study on patients, the success rate of BMV by hook technique was 93.9 vs. 87.2% compared to the E/C technique."

A pilot study was conducted on manikins involving 63 medical staff members who used the hook technique for ventilation. Subsequently, the researchers obtained patient guardian consent and ethical approval to perform the study on 492 emergency department (ED) patients. These patients were randomly categorized into three groups, with each group subjected to one of three ventilation techniques.

The study focused on patients requiring reliable airway management for rapid sequence intubation (RSI). A bag-mask device connected to the capnograph was used to administer ventilation. End-tidal CO2 (ETCO2) levels were recorded. SPSS software version 22 collected and analyzed demographic data. Success rates were reported as frequency (percentage) and mean ± standard deviation.

The study revealed the following findings:

· Comparison of partial pressure of CO2 (PCO2) results obtained via capnography between T/E, E/C and hook techniques showed that the successful ventilation rate was 87.2% for T/E, 89.6% for E/C, and 93.3% for the hook methods.

· The hook method demonstrated a significantly higher success rate compared to the other two techniques.

· Statistically significant trends were observed in PCO2 changes between measurements, both within and between groups.

"The results expressed that due to the chin lift manoeuvre, while the mask is fixed on the face, this method can be suggested as a new Bag-Mask Ventilation method for resuscitators with small hands and for long-term use without finger pain and fatigue," the investigators wrote.

"This study led to the development of a new method for bad-mask ventilation referred to as the hook method," they concluded.

Reference:

Balafar, M., Pouraghaei, M., Paknezhad, S.P. et al. Evaluation the quality of bag-mask ventilation by E/C, T/E and hook technique (a new proposed technique). BMC Anesthesiol 23, 384 (2023). https://doi.org/10.1186/s12871-023-02349-w