Impact of a Two-Person Mask Ventilation Technique During Neonatal Resuscitation: A Simulation-Based Randomized Controlled Trial.

Abstract

To assess whether the two-person ventilation technique during simulated neonatal resuscitation enables higher ventilation quality compared with the one-person technique, as measured by expiratory tidal volume (eV_T), mask leak, positive inspiratory pressure, respiratory rate, and minute ventilation. We conducted a randomized, cross-over simulation trial including 74 neonatal care providers at the Neonatal Simulation Center, Children's Hospital of Philadelphia. Participants performed bag-mask ventilation using one-person and two-person techniques in a randomized order. Ventilation parameters were recorded using a respiratory function monitor. Visual attention was analyzed using eye-tracking technology. The primary outcome was the time to achieve effective ventilation defined by eV_T between 4-8 ml/kg and mask leak ≤30% for 10 consecutive seconds. No participant achieved the primary ventilation target in either technique. The two-person technique showed higher eV_T (9.7 mL/kg vs 8.4 mL/kg, absolute difference -1.3 mL/kg, 95% CI [-2.4, -0.1], P = .032) and a significant reduction in mask leak (48.9% vs 62.9%, absolute difference of 14.0%, 95% CI [6.4, 22.0], P < .001). Eye-tracking indicated differing visual attention patterns between techniques, with the two-person technique focusing more on the mask and bag (dwell time: 25% one-person vs 34% two-person, P = .13). The two-person ventilation technique was associated with increased eV_T and decreased mask leak during simulated neonatal resuscitation. Further research is needed to evaluate the impact of different ventilation devices and techniques in clinical settings. Since this was a simulation-based study, registration in a clinical trial registry was not required.