Comparative evaluation of two methods for assessing bag-valve-mask ventilation quality: a prospective simulation study

INTRODUCTION: Guidelines for bag-valve-mask (BVM) ventilation issued by the European Resuscitation Council (ERC) and the American Heart Association (AHA) have evolved, largely informed by studies on mechanical ventilation in intensive care units (ICUs), which highlight considerable variability in delivered ventilation volumes. The objective of this study was to evaluate an analytical framework for assessing manual ventilation, in comparison to conventional methods. MATERIAL AND METHODS : Two hundred healthcare professionals were invited to perform BVM ventilation on a manikin over four minutes. Ventilation parameters — including tidal volume (Vt) and ventilation rate (Vr) — were recorded using a SimMan Human Patient Simulator and the Laerdal Learning Application (LLEAP). Ventilation efficiency was assessed using two analytical approaches: 1) the individual mean value across the entire session, and 2) the mean value of each parameter calculated within four consecutive one-minute intervals. Compliance was evaluated against the ERC and AHA guidelines. RESULTS: Analysis using Method 1 revealed non-compliant ventilation rates in 97.5% (ERC) and 99.5% (AHA) of participants. Method 2, which assessed ventilation over segmented time windows, demonstrated even lower rates of compliance. Not a single participant fully met either the ERC or AHA guidelines. CONCLUSIONS: Among the methods analyzed, the segmented time-window approach provides a more accurate assessment of both inter- and intra-individual variability in BVM ventilation.