DOI QR코드

DOI QR Code

Comparison of Ventilation Effects by Mask Type for Proper Health Care of Respiratory Emergency Patients

호흡응급환자의 적절한 헬스케어를 위한 마스크 유형별 환기효과 비교

  • 김태현 (공주대학교 응급구조학과) ;
  • 박시은 (동강대학교 응급구조학과)
  • Received : 2020.09.16
  • Accepted : 2020.10.27
  • Published : 2020.10.31

Abstract

This study is a random allocation similar experimental study to compare and analyze the difference in BVM (Bag-Valve-Mask) ventilation volume according to the characteristics of the rescuer's hand and the type of mask using a standardized mannequin. To this end, the Basic Life Resuscitation Education Center of D University in gwangju. Recruiting 39 students who have completed the basic resuscitation course for emergency medical personnel and the Korean-style specialized cardiac rescue course, In addition to measuring the physical characteristics of the hand, the average amount of ventilation per minute using a bag-mask was measured and analyzed. As a result, the type of mask that was not most affected by the characteristics of the hand and provided adequate Minute Ventilation was the soft type (tube, silicone) mask. On the other hard (tube, silicone) masks were found to be unsuitable for general use as they were greatly affected by the characteristics of workers' hands. COVID-19 is currently increasing the risk of transmission to paramedics and patients. Considering this situation, the universal use of a semi-permanent hard-type mask, which is disadvantageous not only for preventing infection but also for proper ventilation, should be avoided. In addition to the ease of use, it should be actively utilized in the field by supplying a soft type mask that can provide stable ventilation even with 'predominance recognition' and proper ventilation.

본 연구의 목적은 기도관리의 중요한 장비 중 하나인 bag-mask ventilation (BMV)의 환기 적절성이 상업화된 마스크의 종류에 따라 그리고 처치자의 손의 특성에 따른 영향요인을 분석해 가장 적확한 bag-mask의 종류를 제언해보기 위한 연구이다. 이를 위해 전남지역 D 대학의 기본인명 소생술 교육센터(대한심폐소생협회 등록기관)에 응급의료종사자를 위한 기본소생술 과정 및 한국형 전문심장구조술 과정을 수료한 학생을 39명을 모집하여, 손의 신체적 특성을 측정함은 물론, bag-mask를 이용한 분당 평균환기량을 측정 및 분석하였다. 결과적으로 손의 특성에 가장 영향을 받지 않고 적절한 환기량이 제공되는 마스크 유형은 Soft type(tube, silicon)의 마스크였다. 반면 Hard type(tube, silicon)의 마스크는 처치자의 손의 특성에 유의미한 영향을 받아 보편적으로 사용하기에 부적절함을 알 수 있었다. 현재 COVID-19로 인해 구급대원과 환자들에게 감염의 위험도는 증가하고 있다. 이러한 상황들을 고려했을 때 감염방지는 물론, 적절한 환기량에도 불리한 반영구 Hard type 마스크의 보편적 사용은 지양되어야 할 것으로 생각되며, 이에 환자 및 처치자의 감염 방지(1회 용) 용이성은 물론 적절한 환기량에서도 안정적인 환기량을 제공 가능한 Soft type 마스크의 '장점 인식'과 공급을 통해 현장에서 적극적으로 활용돼야 할 것이다.

Keywords

References

  1. Link, M.S., Berkow, L.C., Kudenchuk, P.J., Halperin, H.R., Hess, E.P., Moitra, V.K., ... & White, R.D.(2015). American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 132(2): S444-S464.
  2. Kleinman, M.E., Brennan, E.E., Goldberger, Z.D., Swor, R.A., Terry, M., Bobrow, B.J., ... & Rea, T.(2015). Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 132(2): S414-S435.
  3. Odegaard, S., Pillgram, M., Berg, N.E.V., Olasveengen, T., & Kramer-Johansen, J.(2008). Time Used for Ventilation in Two-rescuer CPR with a Bag-valve-mask Device during Out-of-hospital Cardiac Arrest. Resuscitation, 77(1): 57-62. https://doi.org/10.1016/j.resuscitation.2007.11.005
  4. Joffe, A.M., Hetzel, S., & Liew, E.C.(2010). A Two-handed Jaw-thrust Technique is Superior to the One-handed"EC-clamp" Technique for Mask Ventilation in the Apneic Unconscious Person. Anesthesiology: The Journal of the American Society of Anesthesiologists, 113(4): 873-879 https://doi.org/10.1097/ALN.0b013e3181ec6414
  5. Otten, D., Liao, M.M., Wolken, R., Douglas, I.S., Mishra, R., Kao, A., ... & Haukoos, J.S.(2014). Comparison of Bag-valve-mask Hand-sealing Techniques in a Simulated Model. Annals of Emergency Medicine, 63(1): 6-12. https://doi.org/10.1016/j.annemergmed.2013.07.014
  6. Jude, J.R.(2003). Personal Reminiscences of the Origin and History of Cardiopulmonary Resuscitation(CPR). American Journal of Cardiology, 92(8): 956-963. https://doi.org/10.1016/S0002-9149(03)00977-9
  7. Eisenburger, P., & Safar, P.(1999). Life Supporting First Aid Training of the Public- review and Recommendations. Resuscitation, 41(1): 3-18. https://doi.org/10.1016/S0300-9572(99)00034-9
  8. 이남종, 백미례(2018). 백-밸브-마스크 환기 시 마스크 밀착방법에 따른 환기효과 비교. 한국응급구조학회지, 22(1): 73-82. https://doi.org/10.14408/KJEMS.2018.22.1.073
  9. Redfern, D., Rassam, S., Stacey, M.R., & Mecklenburgh, J.S.(2006). Comparison of Face Masks in the Bag-mask Ventilation of a Manikin1. European Journal of Anaesthesiology, 23(2): 169-172. https://doi.org/10.1017/S0265021505002103
  10. Thomas, A.N., Dang, P.T., Hyatt, J., & Trinh, T.N.(1992). A New Technique for Two-hand Bag Valve Mask Ventilation. British Journal of Anaesthesia, 69(4): 397-398. https://doi.org/10.1093/bja/69.4.397
  11. Gerstein, N.S., Carey, M.C., Braude, D.A., Tawil, I., Petersen, T.R., Deriy, L., & Anderson, M.S.(2013). Efficacy of Face Mask Ventilation Techniques in Novice Providers. Journal of Clinical Anesthesia, 25(3): 193-197. https://doi.org/10.1016/j.jclinane.2012.10.009
  12. Na, J.U., Han, S.K., Choi, P.C., Cho, J.H., & Shin, D.H.(2013). Influence of Face Mask Design on Bag-valve-mask Ventilation Performance: A Randomized Simulation Study. Acta Anaesthesiologica Scandinavica, 57(9): 1186-1192. https://doi.org/10.1111/aas.12169
  13. Wang, H.E., Schmicker, R.H., Daya, M.R., Stephens, S.W., Idris, A.H., Carlson, J.N., ... & Puyana, J.C.J.(2018). Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-hour Survival in Adults with Out-of-hospital Cardiac Arrest: A Randomized Clinical Trial. Journal of the American Medical Association, 320(8): 769-778. https://doi.org/10.1001/jama.2018.7044
  14. Adnet, F., Jouriles, N.J., Le Toumelin, P., Hennequin, B., Taillandier, C., Rayeh, F., ... & Fleury, M.(1998). Survey of Out-of-hospital Emergency Intubations in the French Prehospital Medical System: A Multicenter Study. Annals of Emergency Medicine, 32(4): 454-460. https://doi.org/10.1016/S0196-0644(98)70175-1
  15. Hansen, M.L., Lin, A., Eriksson, C., Daya, M., McNally, B., Fu, R., ... & CARES Surveillance Group.(2017). A Comparison of Pediatric Airway Management Techniques during Out-of-hospital Cardiac Arrest using the CARES Database. Resuscitation, 120: 51-56. https://doi.org/10.1016/j.resuscitation.2017.08.015
  16. McMullan, J., Gerecht, R., Bonomo, J., Robb, R., McNally, B., Donnelly, J., ... & CARES Surveillance Group.(2014). Airway Management and Out-of-hospital Cardiac Arrest Outcome in the CARES Registry. Resuscitation, 85(5): 617-622. https://doi.org/10.1016/j.resuscitation.2014.02.007
  17. Arslan Hanif, M., Kaji, A.H., & Niemann, J.T.(2010). Advanced Airway Management Does not Improve Outcome of out-of-hospital Cardiac Arrest. Academic Emergency Medicine, 17(9): 926-931. https://doi.org/10.1111/j.1553-2712.2010.00829.x
  18. Fouche, P.F., Simpson, P.M., Bendall, J., Thomas, R.E., Cone, D.C., & Doi, S.A.(2014). Airways in Out-of-hospital Cardiac Arrest: Systematic Review and Meta-analysis. Prehospital Emergency Care, 18(2): 244-256. https://doi.org/10.3109/10903127.2013.831509
  19. Wang, H.E., Szydlo, D., Stouffer, J A., Lin, S., Carlson, J.N., Vaillancourt, C., ... & Koenig, K.(2012). Endotracheal Intubation versus Supraglottic Airway Insertion in Out-of-hospital Cardiac Arrest. Resuscitation, 83(9): 1061-1066. https://doi.org/10.1016/j.resuscitation.2012.05.018
  20. Lupton, J.R., Schmicker, R.H., Stephens, S., Carlson, J.N., Callaway, C., Herren, H., ... & Wang, H.(2020). Outcomes with the Use of Bag-valve-mask Ventilation during Out-of-hospital Cardiac Arrest in the Pragmatic Airway Resuscitation Trial. Academic Emergency Medicine, 27(5): 366-374. https://doi.org/10.1111/acem.13927
  21. Khoury, A., Hugonnot, S., Cossus, J., De Luca, A., Desmettre, T., Sall, F.S., & Capellier, G.(2014). From Mouth-to-mouth to Bag-valve-mask Ventilation: Evolution and Characteristics of Actual Devices-A Review of the Literature. BioMed Research International, Volume 2014, Article ID 762053, 6 pages.
  22. Cho, Y.C., Cho, S.W., Chung, S.P., Yu, K., Kwon, O.Y., & Kim, S.W.(2011). How Can a Single Rescuer Adequately Deliver Tidal Volume with a Manual Resuscitator? An Improved Device for Delivering Regular Tidal Volume. Emergency Medicine Journal, 28(1): 40-43. https://doi.org/10.1136/emj.2010.099911
  23. Jabre, P., Penaloza, A., Pinero, D., Duchateau, F.X., Borron, S.W., Javaudin, F., ... & Heidet, M.(2018). Effect of Bag-mask Ventilation vs Endotracheal Intubation during Cardiopulmonary Resuscitation on Neurological Outcome after Out-of-hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. Journal of the American Medical Association, 319(8): 779-787. https://doi.org/10.1001/jama.2018.0156
  24. Nagao, T., Kinoshita, K., Sakurai, A., Yamaguchi, J., Furukawa, M., Utagawa, A. Tanjoh, K.(2012). Effects of Bag-mask versus Advanced Airway Ventilation for Patients Undergoing Prolonged Cardiopulmonary Resuscitation in Pre-hospital Setting. The Journal of Emergency Medicine, 42(2); 162-170. https://doi.org/10.1016/j.jemermed.2011.02.020