Optimizing Preoxygenation for Prehospital Emergency Anesthesia and Air Medical Transport: A Comparative Study of Bag Refill Valve and Reservoir Bag.
Air medical journal · 2025-01-01 · Randomised trial
Abstract
OBJECTIVE: Oxygen desaturation is a complication of prehospital rapid sequence intubation before air medical transport. Preoxygenation with a self-inflating resuscitator (ie, bag-valve-mask [BVM]) device and a reservoir bag at 15 L/min oxygen flow (BVM15) is effective at extending safe apnea time. The impact of a lightweight, oxygen-sparing bag refill valve (RV) connector on preoxygenation efficacy is unclear. The objective of this study was to compare preoxygenation with a BVM with a RV connector (BVM + RV) with a BVM with a reservoir bag at 15 L/min oxygen flow (BVM15). The primary outcome was percentage of end-tidal oxygen concentration (EtO2) at 60 and 180 seconds. Secondary outcomes included EtO2 at 60 and 180 seconds when nasal cannula at 15 L/min oxygen flow (NC) was added to these preoxygenation methods (BVM + RV + NC and BVM15 + NC). METHOD: Healthy volunteers were recruited and randomly allocated to receive 3 minutes of preoxygenation using each of the 4 methods (BVM + RV, BVM15, BVM + RV + NC, BVM15 + NC). RESULTS: This pilot study found no significant difference in the EtO2 levels at 60 and 180 seconds between the BVM plus RV and BVM15. However, the addition of NC to the BVM15 setup significantly improved the rate of EtO2 rise. CONCLUSION: Preoxygenation using either a BVM plus RV or BVM15 achieves adequate EtO2 in healthy volunteers. The addition of NC further enhances rise in EtO2 levels. Although more research is needed, the RV may be an alternative device to facilitate preoxygenation in air medical services.
Tags
Endotracheal intubation · Other drugs · Oxygen · Rapid sequence intubation