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Mask leak in one-person mask ventilation compared to two-person in newborn infant manikin study
  1. M B Tracy1,2,
  2. J Klimek1,2,
  3. H Coughtrey1,2,
  4. V Shingde1,2,
  5. G Ponnampalam1,
  6. M Hinder1,
  7. R Maheshwari1,
  8. S K Tracy2,3
  1. 1Nepean Hospital Sydney West Area Health Service, Sydney, Australia
  2. 2University of Sydney, Sydney, Australia
  3. 3Royal Hospital for Women, Sydney, Australia
  1. Correspondence to Dr Mark Tracy, Nepean Neonatal Intensive Care Unit, Nepean Hospital, Derby Street Kingswood 2747, PO Box 63, Penrith 2751 Sydney, Australia; mark.tracy{at}


Aim To compare a new two-person method (four hands) of delivering mask ventilation with a standard one-person method using the Laerdal self-inflating bag (SIB) and the Neopuff (NP) infant resuscitator in a manikin model.

Background Recent studies of simulated neonatal resuscitation using bag and mask ventilation techniques have shown facemask leak levels of 55–57% in expert hands.

Methods 48 participants were randomly paired and instructed to give mask ventilation for a 2-min period as single-person resuscitators, then as two-person paired resuscitators at set pressures for NP and set parameters for SIB. Airway pressure, flow, inspiratory tidal volume, expiratory tidal volume and mask leak were recorded.

Results A total of 21 578 inflations were recorded and analysed. For SIB, mask leak was greater (11.5%) with single-person compared to two-person (5.4%; mean difference 6.1%, 95% CI 1.5 to 10.7, p<0.01). For NP, mask leak was greater for single-person (22.2%) compared to two-person (9.1%; mean difference 13.1% 95% CI 3.6 to 22.6, p<0.01). For single-person mask ventilation, mask leak was greater with NP (22.2%) compared to SIB (11.5%; mean difference 10.7%, 95% CI 1.4 to 19.7, p<0.01). For two-person mask ventilation, mask leak was greater for NP (9.1%) compared to SIB (5.4%; mean difference 3.7%, 95% CI 0.1 to 6.4, p<0.05).

Conclusions Two-person mask ventilation technique reduces mask leak by approximately 50% compared to the standard one-person mask ventilation method. NP mask ventilation has higher mask leak than Laerdal SIB for both single- and two-person technique mask ventilation.

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Human Research and Ethics Committee Sydney West Area Health Service, Nepean Campus.

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