Materials and methods
To design this study, we initially conducted a pilot study on manikins with participation of 63 emergency medicine residents who were eligible for airway management.This pilot study aimed to evaluate the effectiveness of the hook method, a technique involving the resuscitator’s palm on the mask pads front and fingers guiding the patients chin upwards. This approach was subsequently compared to the E/C and T/E techniques. A divider was used to ensure that the recorder assistant remined blinded to the BMV technique employed. Chest rises quality was recorded for all three techniques. Upon successful outcomes from the manikin pilot study, and after obtaining ethical approval and consent from patient’s guardians, we proceeded to enroll 492 patients admitted to ED. Sample size was calculated based on pilot study considering a power of 80% and a type one error of less than 0.05. These patients were randomly divided into three groups using After the screening, pre-oxygenation, premedication, and induction of anesthesia, patients were ventilated by a bag-mask attached to a capnograph by an emergency medicine specialist, senior resident, or emergency attending. Twelve breaths/min with 100% FIO2 were given. We used the RESPIRONICS brand capnograph device, the product of Respironics, Inc. with specifications of Cosmas Court 2271, Carlsbad, CA USA 92,009 was used. Capnography device is a standard calibrated device and its gold standard for improving ventilation with Bag - Mask. The ETCO2 sensor placed between mask’s inlet and bag’s connector part (outlet). Depending on whether patients were in group I, II or III, before induction of anesthesia, patients were ventilated 8 times by bag-mask and at the end of each ventilation, ETCO2 was recorded. BMV success assessment is defined as follows: Increase ET CO2 to more than 20 mmHg and return to baseline [
Flow chart of the study