Manual Resuscitators: Some Inconvenient Truths

The Old Testament appears to describe the successful application of mouth-to-mouth resuscitation of a child, some 2,900 years ago (II Kings 4:34). According to O’Donnell and colleagues,1 the Babylonian Talmud describes a similar event 2,300 years ago: “One may give a woman (about to give birth) all assistance possible.... One may violate the Sabbath on her account.” What is meant by “being of assistance”? “Holding up the young, blowing air into its nostrils, and leading it to its mother’s breast, so that it may suck.” In the ensuing centuries, a dizzying array of techniques to aid in resuscitating the newborn have been described. Looking through the “retro-spectroscope” we can now appreciate that some of these techniques were not particularly efficacious. They included: swinging the infant upside down; squeezing the chest; raising and lowering the arms while an assistant compresses the chest; rhythmic traction of the tongue; tickling the chest, mouth, or throat; yelling; shaking; dilating the rectum with a raven’s beak or a corn cob; immersion in cold water, sometimes alternating with immersion in hot water; rubbing, slapping, or pinching; electric shocks; nebulized brandy (my personal favorite); a hyperbaric chamber in which pressure was increased 1–3 psi every few minutes, to mimic labor; insufflation of oxygen into the stomach; and, last but certainly not least, insufflation of tobacco smoke into the rectum.1 We appear to have come a long way, baby. Of course, the technology for resuscitation of newborns has vastly improved, but we continue to have variation in techniques and opinions about the best methods and equipment. Today, newborns require resuscitation more frequently than any other patient population within the hospital setting,2 and one of the more common interventions is positive-pressure ventilation with a manual resuscitator. Worldwide, in 2003, nearly 10 million newborns required some type of resuscitation.3 The most commonly used manual resuscitators fall into 2 categories: flow-inflating bag, and self-inflating bag.