The Effect of Hand Size, Resuscitator Brand, and Use of Two Hands on Volumes Delivered during Adult Bag-Valve Ventilation

The purpose of this study was to evaluate the effect of hand size, resuscitator brand, and use of two hands on the volumes delivered during adult bag-valve ventilation. METHOD: We recruited 7 persons with small hands, 7 persons with medium hands, and 7 persons with large hands to participate in the study. Hand size was determined by right-hand fit into a medical glove. Ventilation was delivered into a Vent-Aid Training Test Lung, and volumes were measured with a BEAR VM-90 vortex spirometer. In random order, each participant ventilated the test lung with one hand and two hands, and each of the following adult resuscitators: Ambu, BagEasy, 1st Response, Hudson, Laerdal, Hope III, PMR, Pulmanex, and Stat Blue. Volume and rate were measured for 1 min, and the mean tidal volume was calculated. RESULTS: The mean ± SD volumes were: small one-hand = 0.58 ± 0.09 L, small two-hand = 0.79 ± 0.17 L, medium one-hand = 0.70 ± 0.12 L, medium two-hand = 0.92 ± 0.20, large one-hand = 0.84 ± 0.12, large two-hand = 1.01 ± 0.18 L (p < 0.001 by ANOVA for hand size and one hand vs two hands). The mean delivered volumes for the resuscitators were: Ambu = 0.80 ± 0.20 L, BagEasy = 0.93 ± 0.28 L, 1st Response = 0.82 ± 0.18 L, Hudson = 0.84 ± 0.18 L, Laerdal = 0.83 ± 0.19 L, Hope III = 0.86 ± 0.18 L, PMR = 0.75 ± 0.16 L, Pulmanex = 0.80 ± 0.22 L, Stat Blue = 0.65 ± 0.17 L (p < 0.001 by ANOVA). CONCLUSIONS: There were significant differences between volumes delivered by various resuscitators that may be clinically important in some cases. Two hands should be used during bag-valve ventilation, particularly when the operator does not have large hands.