Comparison of Aerosol Generation Between Bag Valve and Chest Compression-Synchronized Ventilation During Simulated Cardiopulmonary Resuscitation

TL;DR

This study compares aerosol generation during simulated CPR using two ventilation methods and finds that chest compression-synchronized ventilation produces fewer aerosols than bag valve ventilation.

Contribution

The study provides novel evidence that CCSV reduces aerosol exposure compared to BV during resuscitation.

Findings

Aerosol particle counts with CCSV stabilized after 3 minutes, while BV counts continued to rise.

CCSV showed significantly lower peak and time-averaged aerosol particle counts than BV.

Posterior probability that CCSV generated fewer particles exceeded 0.98 from 4 to 10 minutes.

Abstract

Background: Cardiopulmonary resuscitation can generate aerosols, potentially exposing healthcare workers (HCWs) to infection. Bag valve ventilation (BV) is widely used but is prone to aerosol dispersion, whereas chest compression-synchronized ventilation (CCSV) maintains a closed respiratory circuit. In this study, we compared aerosol generation between CCSV and BV during chest compressions following endotracheal intubation in a simulated resuscitation setting. Methods: In a randomized crossover design, 12 sessions each of CCSV and BV were conducted on an intubated manikin undergoing mechanical chest compressions for 10 min. Aerosols with ≤5-μm diameter were generated using a saline nebulizer and measured every minute with a particle counter positioned 50 cm from the chest compression site. Bayesian linear regression of minute-by-minute log-transformed aerosol particle counts was used to estimate group differences, yielding posterior means, 95% credible intervals, and posterior probabilities. Results: The aerosol particle counts increased during the initial 3 min with the use of both methods. Thereafter, the aerosol particle counts with CCSV stabilized, whereas those with BV continued to increase. From 4 to 10 min, the posterior probability that CCSV generated fewer particles exceeded 0.98, peaking at 9 min. Both peak and time-averaged log-transformed aerosol particle counts were significantly lower with CCSV than with BV (p = 0.010 and p = 0.020, respectively). Conclusions: In this simulation, CCSV generated significantly fewer aerosols than BV did during chest compressions, with differences emerging after 4 min and persisting thereafter. Thus, CCSV may reduce aerosol exposure of HCWs, supporting its early implementation during resuscitation in infectious disease settings.

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