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Neonatal mannequin comparison of the Upright self-inflating bag and snap-fit mask versus standard resuscitators and masks: leak, applied load and tidal volumes
  1. Anthony Richard Rafferty1,2,
  2. Lucy Johnson1,3,
  3. Peter G Davis1,2,4,
  4. Jennifer Anne Dawson1,2,
  5. Marta Thio1,2,5,
  6. Louise S Owen1,2
  1. 1 Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Victoria, Australia
  2. 2 Neonatal Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  3. 3 School of medicine, Deakin University, Melbourne, VIC, Australia
  4. 4 Dept. of Obstetrics and Gynaecology, University Of Melbourne, Melbourne, VIC, Australia
  5. 5 PIPER Neonatal Retrieval, The Royal Women’s Hospital, Parkville, Victoria, Australia
  1. Correspondence to Dr Louise S Owen, Newborn Research Centre, The Royal Women’s Hospital, Murdoch Children’s Research Institute, The University of Melbourne, Dept. of Obstetrics and Gynaecology, Melbourne, VIC 3052, Australia; louise.owen{at}


Objective Neonatal mask ventilation is a difficult skill to acquire and maintain. Mask leak is common and can lead to ineffective ventilation. The aim of this study was to determine whether newly available neonatal self-inflating bags and masks could reduce mask leak without additional load being applied to the face.

Design Forty operators delivered 1 min episodes of mask ventilation to a mannequin using the Laerdal Upright Resuscitator, a standard Laerdal infant resuscitator (Laerdal Medical) and a T-Piece Resuscitator (Neopuff), using both the Laerdal snap-fit face mask and the standard Laerdal size 0/1 face mask (equivalent sizes). Participants were asked to use pressure sufficient to achieve ‘appropriate’ chest rise. Leak, applied load, airway pressure and tidal volume were measured continuously. Participants were unaware that load was being recorded.

Results There was no difference in mask leak between resuscitation devices. Leak was significantly lower when the snap-fit mask was used with all resuscitation devices, compared with the standard mask (14% vs 37% leak, P<0.01). The snap-fit mask was preferred by 83% of participants. The device-mask combinations had no significant effect on applied load.

Conclusions The Laerdal Upright Resuscitator resulted in similar leak to the other resuscitation devices studied, and did not exert additional load to the face and head. The snap-fit mask significantly reduced overall leak with all resuscitation devices and was the mask preferred by participants.

  • neonatology
  • resuscitation
  • respiratory

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  • Funding This study was financially supported by NHMRC funding (APP1059111, APP6067889, APP1111134 and APP1090678).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.