# Measuring ventilation in pediatric simulations using a novel adjustable bag-valve-mask resuscitator: a comparative study with the Butterfly BVM and the traditional Ambu bag

## TL;DR

A new adjustable resuscitator improves ventilation accuracy in pediatric simulations compared to traditional devices.

## Contribution

The Butterfly BVM significantly improves minute ventilation delivery and reduces tidal volumes in pediatric simulations.

## Key findings

- Users were 10x more likely to deliver target minute ventilation with the Butterfly BVM.
- The Butterfly BVM resulted in significantly lower average tidal volumes compared to traditional BVM.
- Most participants found the Butterfly BVM intuitive and easy to use.

## Abstract

•We compared the Butterfly Bag-Valve Mask (BVM) to traditional BVM in pediatric simulations.•Users were 10x more likely to deliver target minute ventilation with the Butterfly BVM.•Tidal volumes were significantly lower with the Butterfly BVM than traditional BVM.•Most participants found the Butterfly BVM intuitive and easy to use.

We compared the Butterfly Bag-Valve Mask (BVM) to traditional BVM in pediatric simulations.

Users were 10x more likely to deliver target minute ventilation with the Butterfly BVM.

Tidal volumes were significantly lower with the Butterfly BVM than traditional BVM.

Most participants found the Butterfly BVM intuitive and easy to use.

Ventilation using bag-valve-mask (BVM) resuscitators is commonly associated with excessive ventilation volumes and rates, even among trained providers. This can lead to volutrauma, particularly in pediatric patients as lung volumes vary by age and weight. The Butterfly BVM is a novel, adjustable device designed to regulate volume, rate, and peak inspiratory pressure to promote safer ventilation.

To compare minute ventilation (MV) and tidal volume (Vt) delivery using the Butterfly BVM versus a traditional BVM (Ambu Spur II) among interprofessional teams during simulated pediatric resuscitations.

In this prospective simulation-based study, 42 participants (physicians, nurses, EMTs) provided manual ventilation to infant and adolescent mannequins using a traditional and Butterfly BVM. Primary outcome was MV delivery; secondary outcomes included Vt delivery and user feedback. Data were analyzed using generalized linear mixed models.

Participants were significantly more likely to deliver MV within target range using the Butterfly BVM (73.8 %) versus the traditional BVM (32.1 %; OR = 10.5, 95 % CI: 4.1–26.5; p < 0.0001). The Butterfly BVM also resulted in significantly lower average Vt (LSMean = –164.3 mL; p < 0.0001). Users found the device easy to use (69.0 %) and intuitive (73.8 %), citing its ability to decrease cognitive load and risk of overventilation.

The Butterfly BVM significantly improves delivery of MV and Vt during simulated pediatric resuscitations compared to a traditional BVM. Its adjustable controls for respiratory parameters offer a promising solution to prevent volutrauma during pediatric ventilation. Further studies are warranted to validate these findings in real-world settings.