Written by Kimiko Dunbar
Spoon Feed
Two-person mask ventilation in simulation newborn resuscitation improves air leak but results in excessive tidal volumes.
It takes two, baby?
Effective bag-mask ventilation is an essential component of NRP. Prior studies have indicated ventilation techniques might be better with a 2-person technique. This simulation-based randomized crossover trial examined whether a two-person mask ventilation technique improves neonatal ventilation quality versus a one-person technique. The simulation utilized a respiratory function monitor to obtain data on ventilation parameters, such a leak and tidal volumes. Among 74 healthcare providers (including MD, RN, RT), the two-person method yielded significantly higher expiratory tidal volumes (9.7 vs. 8.4 mL/kg, P = .032) and lower mask leak (48.9% vs. 62.9%, P < .001). No participant met the primary target (expiratory tidal volume range of 4-8 mL/kg and no more than 30% leak). Limitations include simulation environment, use of flow-inflating bags exclusively, and heterogeneous provider experience. Overall, two-person technique improves certain ventilation parameters but does not ensure optimal target achievement.
How does this change my practice?
It’s notable (and concerning) that no participants consistently achieved ventilation targets with one or two person techniques. While there was less leak with two participants, over-ventilation was present putting the infant at risk of barotrauma. That said, it’s really hard to know how this would translate to a live infant. We’ve all interacted with sim babies, and in my experience, ventilating a mannequin is quite different than the real deal. Perhaps I’ll be more inclined to use two providers if having difficulty achieving an adequate seal, but overall, this underscores the need to stay sharp in airway maintenance. After all, most pediatric codes are respiratory in origin.
Source
Impact of a Two-Person Mask Ventilation Technique During Neonatal Resuscitation: A Simulation-Based Randomized Controlled Trial. J Pediatr. 2025 Mar 28;282:114568. doi: 10.1016/j.jpeds.2025.114568. Epub ahead of print. PMID: 40158839
