Newborn self-inflating manual resuscitators: precision robotic testing of safety and reliability

Arch Dis Child Fetal Neonatal Ed. 2019 Jul;104(4):F403-F408. doi: 10.1136/archdischild-2018-315391. Epub 2018 Oct 18.

Abstract

Aim: A controlled bench test was undertaken to determine the performance variability among a range of neonatal self-inflating bags (SIB) compliant with current International Standards Organisation (ISO).

Introduction: Use of SIB to provide positive pressure ventilation during newborn resuscitation is a common emergency procedure. The United Nations programmes advocate increasing availability of SIB in low-income and middle-income nations and recommend devices compliant with ISO. No systematic study has evaluated variance in different models of neonatal SIB.

Methods: 20 models of SIB were incrementally compressed by an automated robotic device simulating the geometry and force of a human hand across a range of precise distances in a newborn lung model. Significance was calculated using analysis of variance repeated measures to determine the relationship between distance of SIB compression and delivered ventilation. A pass/fail was derived from a composite score comprising: minimum tidal volume; coefficient of variation (across all compression distances); peak pressures generated and functional compression distance.

Results: Ten out of the 20 models of SIB failed our testing methodology. Two models could not provide safe minimum tidal volumes (2.5-5 mL); six models exceeded safety inflation pressure limit >45 cm H2O, representing 6% of their inflations; five models had excessive coefficient of variation (>30% averaged across compression distances) and three models did not deliver inflation volumes >2.5 mL until approximately 50% of maximum bag compression distance was reached. The study also found significant intrabatch variability and forward leakage.

Conclusion: Compliance of SIBs with ISO standards may not guarantee acceptable or safe performance to resuscitate newborn infants.

Keywords: SIB; bag mask ventilation; newborn resuscitation; positive pressure ventilation; self inflating bag.

Publication types

  • Evaluation Study

MeSH terms

  • Cardiopulmonary Resuscitation / instrumentation
  • Equipment Design
  • Equipment Safety
  • Humans
  • Infant Care / instrumentation*
  • Infant Care / methods
  • Infant, Newborn
  • Insufflation / methods*
  • Positive-Pressure Respiration / instrumentation*
  • Positive-Pressure Respiration / methods
  • Respiration, Artificial / instrumentation*
  • Respiration, Artificial / methods
  • Robotics / instrumentation*