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

Abstract

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.