Reflection on a patient's airway management during a ward-based resuscitation

BACKGROUND: The bag-valve-mask (BVM) system is a common adjunct used during adult resuscitation to ventilate the lungs and deliver oxygen to patients in cardiopulmonary arrest. Gastric inflation, regurgitation and aspiration are well-documented complications of BVM ventilation, which can have serious consequences for patients. AIM: The aim of this paper is to review the cause of gastric inflation, regurgitation and aspiration during BVM ventilation and to consider techniques that have been suggested to reduce these problems. METHOD: Using a reflective model, the author revisits an actual cardiac arrest, and within a structured framework considers the event itself, the context of the event and looks at ways in which practice could be improved in future. RESULTS: It is clear from the evidence that a reduction in peak airway pressure can reduce the risk of gastric inflation, regurgitation and aspiration. A review of the available research strongly suggests that in expert hands, the most effective means of reducing peak airway pressure is by reducing tidal volume by using a smaller bag. CONCLUSION: Although the evidence, as presented, for a reduction in bag size is convincing, there appears to be a problem that less regular users do not appear to be able to produce effective tidal volumes when using a smaller bag. If a reduced bag size is standardized, further research using a diverse group of health care workers with the BVM is required before a clear policy can be achieved. It is likely that training and practice will be shown to be important for nursing staff expected to use the smaller BVM.