Retention of ventilation skills of emergency nurses after training with the SMART BAG (R) compared to a standard bag-valve-mask

Background and purpose: Studies show that nurses retain resuscitation skills poorly and that retention of ventilation skills is particularly difficult. We formed the hypothesis that the SMART BAG((R)) (SB, O-Two Medical Technologies Inc., Canada), i.e. a bag-valve-mask device with a pressure/flow responsive valve, would assist nurses in providing more efficient ventilation six months after training. Materials and methods: Prior to training, 39 emergency nurses performed CPR for 2 min, in pairs, using a standard bag-valve-mask device (STBVM, Laerdal, Norway) to assess their base tine skills. A CPR training manikin (Simulaids, USA) equipped with a PEEP valve in the oesophagus set at 20cm H2O was used to measure inspiratory time, tidal volume (Vt), peak pressure and gastric insufflation (Gl). Immediately following training they were tested using an O-Two STBVM and a SB. Half of the nurses were retested after three months, the other half after six months. Efficient ventilation was defined as a mean Vt > 400 ml and Gl < 50 ml in 1 min. Results: Before training, only 16% of nurses ventilated efficiently: 63% had Gl and 28% had Vt < 400 ml. Three months after training the efficiency of the STBVM and the SB was high (81 and 75%, respectively). Six months after training, there was a trend towards higher efficiency for the SB (63%) compared to the STBVM (25%) (p = 0.07). For instances with the STBVM producing a Vt > 400 ml, those without Gl had a lower peak pressure than those with Gl (7.8 cm H2O versus 17.7 cm H2O, p = 0.0001) and showed a trend towards a longer inspiratory time (1.28 s versus 1.08 s, p = 0.08). Of all efficient ventilations with a STBVM, 26% had a Vt > 600 ml. Conclusions: Six months after training, nurses ventilated at Least as efficiently with the SB, compared with the STBVM. This illustrates the ability of the SB to compensate for the deterioration over time in skill. On the other hand, training with a STBVM should focus primarily on prolonging the inspiratory time, and therefore the peak pressure, whilst maintaining an adequate Vt. (c) 2005 Elsevier Ireland Ltd. All rights reserved.