In the midst of the COVID-19 pandemic, hospitals and healthcare providers may experience shortages of critical equipment needed to treat their patients. Many have already begun to search for alternative methods to provide high quality care to patients despite such a shortage.
After watching a YouTube video posted by Scott Weingart of EMCrit on how to utilize a BVM to provide CPAP with a few additions, I experimented with a few pieces of equipment from my lifeguarding days to try and re-create the setup. By utilizing simple, inexpensive, and readily available first aid equipment, providers can inexpensively replicate this method to provide respiratory support to those requiring CPAP in the face of medical equipment shortages. Additionally, equipment traditionally used by lifeguards to provide face mask ventilation of apneic patients may prove beneficial in preventing mask leakage during ventilation, thereby decreasing risk of provider exposure.
As EMCrit has already developed the procedure, I will provide their link rather than re-explain the science behind the device. You can view the video on creating CPAP with a BVM HERE After viewing the link and becoming familiar with the setup, I turned to some leftover lifeguarding CPR equipment in an attempt to recreate the setup. I utilized the following products to add to a traditional adult BVM to provide the post-stem oxygen flow essential for creating PEEP, and also potentially reduce provider exposure to particulates associated with traditional BVM use.
Pictured below on the left, the Phillips oxygen adapter is designed for providing supplemental oxygen via the Seal-rite mask. When utilized in conjunction with an Ambu brand BVM, the adapter fits well and provides an excellent seal. This simple piece is available online for less than $5, and prevents having to attempt to combine other pieces of equipment for the same purpose (such as an in-line CO2 port). Addition of the adapter to the BVM between the mask and bag (and potentially with a viral filter in place as well) can provide additional PEEP for patients. On the right is a Seal Rite CPR facemask, also available online for about $5. The benefit to this type of mask is that instead of a rigid plastic design, it features a round flexible disc that can be easily applied to the patient’s face and obtain an excellent seal regardless of moisture or unique facial anatomy.
Lifeguards are used to using this type of mask as it provides an excellent seal for resuscitation in the aquatic rescue environment; however, in-hospital and prehospital providers may also benefit from using this mask during the COVID pandemic as supplies run short, and as a way to potentially decrease provider exposure during manual ventilation due to the excellent seal. The mask alone (without the Phillips oxygen adapter) is also compatible with an Ambu BVM), meaning providers may choose to use the mask for traditional BVM use if desired.
Pictured below are- 1. An Ambu BVM with the post- stem oxygen adapter and traditional mask for CPAP therapy 2. An Ambu BVM with flexible mask and without post-stem adapter for traditional manual ventilation 3. Combined setup 4. Visual of the flexible mask for effective seal
In addition to re-providing the link to EMCrit’s video on the science behind post-stem oxygen flow and PEEP, I have provided a link to a supplier for the flexible masks and oxygen adapters , as well the link to another great video by Scott Weingard of EMCrit on setting up the BVM for CPAP . I have also included a brief video from myself on setting up the BVM with the post-stem oxygen adapter for PEEP, as well as a review of the setup with the flexible mask for providing excellent seal. Hopefully conditions at your organization won’t necessitate the use of such makeshift devices, but keep these simple and inexpensive products in mind should you decide to implement BVM CPAP. Stay safe out there!
Click Here For Video Demo. Brett Szabo Statement- I am in no way affiliated with nor receiving any financial remuneration from any companies or manufacturers producing or selling the aforementioned or pictured products.
References https://thelifeguardstore.com/seal-rite-without-one-way-valve-22962.html https://thelifeguardstore.com/seal-rite-oxygen-adapter-2349.html https://www.youtube.com/watch?v=QEMBJXfEd2M&list=WL&index=13&t=9s