# A Comparative Evaluation of the Quality and Feasibility of ‘Over-the-Head’ Cardiopulmonary Resuscitation by a Single Rescuer: Pocket Mask vs. Bag-Valve Mask—A Pilot Study

## TL;DR

This study compares two CPR techniques for single rescuers and finds both effective, with the pocket mask being a good option when resources are limited.

## Contribution

The study introduces a practical comparison of over-the-head CPR techniques using a pocket mask versus a bag-valve mask for solo rescuers.

## Key findings

- Both techniques achieved excellent overall CPR quality with no significant differences.
- BVM-OTH provided better ventilation quality than Pocket-OTH.
- Pocket-OTH resulted in more chest compressions and shorter interruptions.

## Abstract

Aim: The present study evaluated the feasibility and quality of cardiopulmonary resuscitation (CPR) performed by a single rescuer, comparing the over-the-head (OTH) technique using mouth-to-pocket mask ventilation with bag-valve mask (BVM) ventilation. The study analyzed the chest compression (CC) quality, ventilation adequacy, interruption minimization, and the rescuers’ perceived difficulty. Methods: A randomized simulation crossover study was conducted with 26 lifeguard students trained in basic life support and both ventilation techniques. All of the participants performed two solo CPR trials (2 min each) using OTH with a pocket mask or BVM on a manikin connected to a feedback system (Little Anne QCPR, Laerdal). The overall CPR quality, ventilation, and CC quality were assessed, along with the perceived difficulty (scale 0–5). A 5 min rest was provided between the trials. Results: The overall CPR quality was excellent for both techniques with a median of 98% (IQR: 97–99) for BVM-OTH and 99% (IQR: 94–99) for Pocket-OTH (p = 0.31). The ventilation quality was better when using BVM-OTH (100%, IQR: 99–100) compared to that with Pocket-OTH (99%, IQR: 77–100; p = 0.046). No differences were found in the CC quality (99%, IQR: 99–100; p = 0.24). However, Pocket-OTH had more CCs and shorter interruption times (p ≤ 0.001). The perceived difficulty was low for both techniques. Conclusions: Both techniques enable high-quality CPR when performed alone. Given that no clinically relevant differences emerged in the resuscitation quality, the OTH technique using a pocket mask offers a viable alternative, particularly in scenarios with a single rescuer and limited resources.