Bag–mask ventilation for a toddler met tidal volume targets in only one breath in six

Design

Randomised crossover simulation study

Population

123 emergency medical services clinicians, toddler manikin

Primary outcome

Adherence to guideline tidal volume, rate and mask seal

Effect

Tidal volume on target 87% vs 16.2% of breaths; rate 88.6% vs 65%

A randomised crossover simulation study in Pediatrics tested 123 emergency medical services clinicians from five US agencies ventilating a three-year-old manikin in respiratory arrest, with and without a real-time ventilation feedback device.

Without feedback, guideline tidal volumes were delivered in 16.2% of breaths and the rate was correct 65% of the time. With feedback, tidal volume was on target in 87% of breaths and rate in 88.6%. Mask seal improved slightly.

Paediatric respiratory arrest is rare for any one clinician, so skills fade. These results suggest that, even among professionals, manual ventilation of a young child is usually off target, most often in volume.

This was a simulation, so it does not show outcomes in real children. But it is a strong argument for regular hands-on practice and, where available, feedback during training.

• Practise paediatric bag–mask ventilation regularly, ideally with feedback on volume and rate
• Use a bag size appropriate to the child and watch for chest rise with each breath
• Check the mask seal; a two-person technique helps when the seal is difficult
• Count the ventilation rate aloud to avoid hyperventilation

Why it matters

A core resuscitation skill was wrong in most breaths, even among experienced clinicians.

Don't overread it

Manikin simulation: better adherence has not been shown to improve outcomes in children.

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