Bag-mask ventilation and basic airway adjuncts: SAQ

This infant is apnoeic, cyanosed and bradycardic with a limp tone — the pre-terminal signature of hypoxia — so the immediate priority is to open the airway and ventilate, because the slow heart rate is the heart's response to hypoxia and ventilation usually reverses it within seconds once the chest rises. Each step rests on choosing the right device, the right technique, and the right rate. ^[2]

Question 1 (10 marks)

Classify the manual ventilation devices, describe your immediate airway and ventilation technique for this infant including the mask and the rate, and state when you would add chest compressions. ^[1]

Manual ventilation devices sort by how they generate the breath. A self-inflating bag re-expands on its own after every squeeze whether or not it is connected to oxygen, so it is the only device that works in a solo resuscitation and is the resuscitation standard. A flow-inflating (anaesthesia) bag needs a continuous gas source and a seal to inflate, so it is for the trained anaesthetist. A T-piece resuscitator delivers a set peak inspiratory pressure and a consistent positive end-expiratory pressure, and is the neonatal standard. For this infant I use a paediatric self-inflating bag with an oxygen reservoir. ^[2]

My technique is to position the infant head neutral — over-extension would obstruct the high anterior airway — suction the visible secretions, and apply a mask that spans the bridge of the nose to the chin with a C-E grip. I squeeze the bag slowly over about one second to produce visible bilateral chest rise, deliberately avoiding a forceful squeeze that would overcome the lower oesophageal sphincter and insufflate the stomach. I use 100 percent oxygen during active resuscitation and wean to a target once return of circulation is achieved. ^[1]

Because this infant is apnoeic with a pulse, this is rescue breathing, and my rate is one breath every 2 to 3 seconds, about 20 to 30 breaths per minute. I would add chest compressions only if the heart rate stays below 60 beats per minute despite at least 30 seconds of effective ventilation with oxygen, at a ratio of 15 compressions to 2 breaths with two rescuers, or 30 to 2 as a single rescuer. I escalate to the two-person technique moment chest does not rise, because that is the single most effective improvement. ^[1]