Ramakkannu Karthikeyan, Theagrajan Annu, Prabhu Manjunath, Ramkumar Venkateswaran
Department of Anesthesiology, Devaki Speciality Hospital, Madurai, IND.
Anesthesiology, Sree Balaji Medical College and Hospital, Chennai, IND.
Cureus. 2024 Feb 7;16(2):e53791. doi: 10.7759/cureus.53791. eCollection 2024 Feb.
Background Bag-mask ventilation is an essential life-saving skill. The E-C technique of mask holding is the most popular. In patients with suspected cervical injury, the jaw thrust maneuver is recommended instead of the E-C technique with head tilt-chin lift. Should jaw thrust fail to produce adequate chest rise, the operator is advised to switch to the E-C technique with the head tilt-chin lift maneuver with head extension as it is vital to move oxygen into the lungs. We hypothesized that the E-C clamp with the head in the neutral position without head tilt might permit adequate ventilation without producing excessive movement of the cervical spine, which in turn might translate as less strain to the cervical spine. Methods In this prospective, randomized, double-blind, crossover study, we evaluated the relative efficacy of three airway maneuvers in opening the airway in anesthetized and paralyzed adults: jaw thrust, two-handed E-C technique with head in the neutral position, and two-handed E-C technique with head fully extended. The tidal volume generated during mechanical ventilation using these three techniques was considered as the primary outcome. Seventy-two subjects were recruited for this trial and all three techniques of mask holding were performed in each of these subjects in a sequence as dictated by a randomization table. Results The jaw thrust technique provided a mean tidal volume significantly higher than the two-handed E-C technique, with the head in the neutral position (p<0.001). Similarly, the two-handed E-C technique with the head fully extended provided a mean tidal volume significantly higher than the two-handed E-C technique with the head in neutral position (p<0.011). The mean tidal volume obtained with jaw thrust and two-handed E-C technique with head fully extended were comparable (p=0.78). Conclusion The two-handed E-C technique with the head fully extended, and the jaw thrust technique both produce good and comparable tidal volumes. The two-handed E-C technique with the head in a neutral position provides adequate though lower tidal volumes as compared to the other two techniques.
袋面罩通气是一项至关重要的救命技能。双手托举面罩的E-C技术最为常用。对于疑似颈椎损伤的患者，建议采用托颌法而非带有仰头抬颌动作的E-C技术。如果托颌法不能使胸廓充分起伏，建议操作者改用带有头部伸展的仰头抬颌动作的E-C技术，因为将氧气输送到肺部至关重要。我们推测，头部处于中立位且无仰头动作的E-C钳夹法可能在不引起颈椎过度移动的情况下实现充分通气，进而可能意味着对颈椎的压力更小。
在这项前瞻性、随机、双盲、交叉研究中，我们评估了三种气道操作方法在麻醉和瘫痪的成年患者中开放气道的相对效果：托颌法、头部处于中立位的双手E-C技术以及头部完全伸展的双手E-C技术。使用这三种技术进行机械通气时产生的潮气量被视为主要结果。本试验招募了72名受试者，按照随机表规定的顺序对每个受试者依次进行所有三种面罩托举技术操作。
托颌法产生的平均潮气量显著高于头部处于中立位的双手E-C技术（p<0.001）。同样，头部完全伸展的双手E-C技术产生的平均潮气量显著高于头部处于中立位的双手E-C技术（p<0.011）。托颌法和头部完全伸展的双手E-C技术获得的平均潮气量相当（p=0.78）。
头部完全伸展的双手E-C技术和托颌法都能产生良好且相当的潮气量。与其他两种技术相比，头部处于中立位的双手E-C技术虽然潮气量较低，但也能提供足够的通气量。
