A comparison of three different mask holds for positive pressure ventilation in neonatal manikins

Background: Establishing effective ventilation is the primary aim of neonatal resuscitation. This is usually initially performed using a face mask, but mask ventilation can be diffi cult due to leak or obstruction. This study aims to compare three different mask holds; the two-point top hold, the two-handed hold and the spider hold, to determine if one is superior.

Method: Medical and nursing staff regularly involved in neonatal resuscitation were asked to participate. Participants were shown the different holds and asked to deliver positive pressure ventilation using each hold in a random order for one minute to a manikin using the following settings: PIP of 30 cmH2O, PEEP of 5 cmH2O, and 40–60 infl ations per minute. Expiratory leak, tidal volumes, airway pressure measurements, professional group, participants’ years of experience with neonatal resuscitation, glove size and hold preferences were recorded.

Results: 53 participants were enrolled and 7,324 infl ations were studied. The results are presented in table 1.

Conclusions: No single hold was performed best by a majority of participants. Less experienced staff may benefi t from the two-handed approach. More experienced medical staff had a reduced leak with the two point top hold which would be the hold they are most familiar with. Operators with larger sized hands had least leak when using the spider hold.