An Overview of Mechanical Ventilation and Emergency Ventilators

Ventilation plays a crucial role in caring for patients in emergency situations. In extreme situations, it can maintain respiratory function and ensure oxygen supply if the patient is unable to breathe on their own. Mechanical ventilation offers a number of advantages compared to manual ventilation, and can be life-saving.[1]

WEINMANN Emergency supports mechanical ventilation in emergency situations with a range of emergency and transport ventilators.

Definition: What is mechanical ventilation?

Spontaneous breathing is an autonomous, physiological process which, in a healthy person, takes place continuously and without conscious control, especially during sleep. However, under certain pathophysiological conditions, such as serious trauma or illness, this capacity may be impaired or lost completely. As a result, various ventilation methods are required to support respiratory function.

For manual ventilation, a resuscitator is used via a ventilation mask or tube.

Mechanical ventilation, on the other hand, is a method whereby a ventilator is used to regulate and support alveolar ventilation. This guarantees a constant volume and a constant respiratory rate. Positive airway pressure ensures that the respiratory gas is transported into the lung. 

Why is manual ventilation difficult?

Bag-valve-mask ventilation is a method that is frequently used because it is supposedly easy to do. It involves attaching a resuscitator, which is usually connected to an oxygen source, to a face mask. The mask is held on the patient’s face, covering both nose and mouth. At the same time, the resuscitator is squeezed, causing oxygen to flow through the patient’s airways. The valve prevents the oxygen flowing back into the resuscitator.

In only 3 out of 106 cases were all guideline-relevant ventilation parameters met with bag-valve-mask ventilation during CPR.[2]

Free airways, an adequately sealed mask and the correct technique are key for this procedure. Two first responders are normally required. In actual fact, this method is not easy to implement, and studies show that even experienced EMS providers have difficulties with it.[3]

Most importantly, it lacks is a reliable method for measuring the ventilation volume or the pressure that is exerted on the airways. The delivery of oxygen by squeezing the resuscitator can only be controlled to a limited extent. Without real-time feedback, there is a high risk of dangerous pressure peaks that can cause damage to the lung.

A further problem with bag-valve-mask ventilation can be an excessive ventilation rate with too many breaths per minute.[4] This hyperventilation can have negative effects on the patient’s circulatory condition.

Scenarios involving mechanical ventilation in emergency medicine

Mechanical ventilation is used in various areas of emergency medicine. For example, if the patient has been anesthetized at the emergency site and can no longer breathe on their own. 

In emergency situations such as a cardiac arrest, it is essential to resuscitate the patient as quickly as possible and ensure an adequate oxygen supply. Mechanical ventilation can save lives during resuscitation by maintaining gas exchange in the lung until the patient can breathe independently again. 

Mechanical ventilation is also important for transportation in an ambulance or during patient transfer. It ensures a constant and continuous oxygen supply during transportation, without EMS providers having to leave their seat to administer ventilation. Mechanical ventilation thus also contributes to user safety.

However, ventilators are not only used during invasive ventilation – non-invasive ventilation can also be supported with different ventilation modes, for example when using CPAP therapy to treat a cardiac pulmonary edema.

Advantages of ventilators

Mechanical ventilation offers a number of advantages in direct comparison with bag-valve-mask ventilation. Studies show that it is more effective than manual ventilation. While a bag-valve mask used during resuscitation led to massive hypoventilation in one study, the ventilator was able to ensure more effective ventilation.[5] 

During resuscitation, the use of a mechanical ventilator in IPPV mode is associated with a better ventilation status than the use of a bag-valve mask.

Ventilators are also advantageous when it comes to crew resource management (CRM). Usually, two EMS providers are required for effective bag-valve-mask ventilation. Ideally, one person should attach the mask to the patient’s face and hold it in place, while the other person carries out the actual ventilation. However, this ties two EMS providers to one task, so they cannot do anything else.

Using a ventilator, EMS providers can complete more tasks, document them more fully, and provide the patient with better care.

In contrast, the advantage of ventilators is that EMS providers are freed up to perform other tasks and document the emergency, so the patient can be given better and more effective care.[6] This reduces the manual work required and allows medical staff to concentrate on the cause of the emergency. 

At first glance, the equipment for bag-valve-mask ventilation looks more compact and lighter to carry, but ventilators can also be light and portable. In addition, they are easy to operate, and their functionality is less dependent on the EMS provider’s precise technique than is often the case with bag-valve-mask ventilation.

WEINMANN Emergency ventilators

WEINMANN Emergency ventilators are specially designed for use in emergency situations and are suitable for both outdoors and when transporting patients. They offer the option of invasive or non-invasive ventilation, and facilitate cardiopulmonary resuscitation, in accordance with the guidelines, using CPR mode or CCSV mode.

Integrated monitors allow the ventilation parameters to be observed continuously and provide visual and acoustic warnings in the event of any deviations. This means that both hypoventilation and hyperventilation can be avoided effectively, as precise setting and monitoring functions are provided.

MEDUMAT Transport 

Emergency and transport ventilator

MEDUMAT Transport is very intuitive to operate. Emergency modes and simple height selection make it easy to use right from the start. Eight integrated ventilation modes enable comprehensive adjustment to the patient’s needs. Optimized patient monitoring is ensured by the simultaneous display of three curves.

MEDUMAT Standard² 

Emergency and transport ventilator

MEDUMAT Standard² has a color monitor that displays all essential ventilation parameters clearly and instantly. A specific resuscitation mode (CPR) is enhanced by the innovative CCSV ventilation mode, which maximizes efficiency and safety during critical situations. The RSI mode makes induction of anesthesia easier for the anesthetist. Non-invasive ventilation is also possible with MEDUMAT Standard².

MEDUMAT Standard² weighs just 2.5 kg and has a battery runtime of up to 10 hours, making it ideal for emergency situations. 

MEDUVENT Standard 

Turbine-driven emergency ventilator

MEDUVENT Standard was specially developed for use in emergency situations. With its integrated turbine, it offers ventilation from 21 %-100 % oxygen without any compressed gas supply required. The ventilator supports non-invasive ventilation and enables manual ventilation via MEDUtrigger, which replaces bag-valve-mask ventilation. 

Weighing just 2.1 kg and with a volume of 3.5 l, MEDUVENT Standard is one of the most compact and lightest emergency and transport ventilators of its kind. Additional safety features such as the integrated alarm system warn medical staff in critical situations. 

MEDUMAT EasyCPR

Voice-guided emergency ventilator

MEDUMAT EasyCPR is a ventilator that has been developed specifically for respiratory support both during and after resuscitation. Clear voice instructions ensure maximum safety and guide the user through the resuscitation process. The intuitive operation of MEDUMAT EasyCPR and its compact size make for easy transportation.

If you would like further information or a personal consultation, please don’t hesitate to contact us.

 

[1] Idris Ahamed H. (2023) Bag-Valve-Mask Ventilation and Survival from Out-of-Hospital Cardiac Arrest: A Multicenter Study.

[2] Neth M et al (2020): Ventilation in Simulated Out-of-Hospital Cardiac Arrest Resuscitation Rarely Meets Guidelines

[3]  Neth M et al (2020):  Ventilation in Simulated Out-of-Hospital Cardiac Arrest Resuscitation Rarely Meets Guidelines

Chauhan A. et al (2023) Comparison of hemodynamic consequences of hand ventilation versus machine ventilation for transportation of post-operative pediatric cardiac patients

[4] Aufderheide TP, Sigurdsson G, Pirrallo, RG, Yannopoulos D, McKnite S, Von Briesen C, Sparks CW, Conrad CJ, Provo TA, Lurie KG. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109(16):1960-1965.

[5] Hernández-Tejedor A. (2023): Ventilatory improvement with mechanical ventilator versus bag in non-traumatic out-of-hospital cardiac arrest: SYMEVECA study, phase 1; Chauhan A. et al (2023): Comparison of hemodynamic consequences of hand ventilation versus machine ventilation for transportation of post-operative pediatric cardiac patients

[6] Automatic transport ventilator versus bag valve in the EMS setting: a prospective, randomized trial