Increasing donor heart use in cardiac transplantation.

ABSTRACT: A shortage of donor hearts remains a critical problem in cardiac transplantation, resulting in longer recipient wait times and increased wait list mortality. The disparity between available donor hearts and patients with end-stage heart failure who need transplant is expected to grow. The donor heart pool can be increased by using organs from expanded criteria, Public Health Service increased risk, hepatitis C, and donation after circulatory death donors.

An evaluation of bag-valve-mask ventilation using an ergonomically designed facemask among novice users: a simulation-based pilot study.

PURPOSE: We sought to compare the ability of novice operators to provide artificial ventilation using a standard facemask and a new ergonomically designed facemask. Whether or not proper technique was used was also assessed. METHODS: Thirty-two allied-health students used both masks in random crossover fashion to ventilate an airway trainer. Breaths were delivered by a mechanical ventilator and exhaled tidal volume was recorded for each of 12 breaths for each participant for each mask. The effect of each mask during ventilation over time was assessed using repeated-measures ANOVA. Assessment of mask technique among participants and association between mask type and hand repositioning were analyzed using the Wilcoxon-Rank Sum Test and McNemar's paired proportions test, respectively. RESULTS: The tidal volume achieved when participants used the ergonomic mask was higher than when participants used the standard mask by the fourth breath (361+/-104 mL vs. 264+/-163 mL; Bonferroni adjusted p-value=0.040) and increased over time. The repeated-measures ANOVA showed that the ergonomic mask consistently resulted in higher tidal volumes than the standard mask regardless of rescuer's gender. Over time the standard mask resulted in a linear decrease in tidal volume of -10 mL/breath (estimated difference in decay of 10 mL/breath versus the ergonomic mask; p<0.001). CONCLUSION: Novice airway operators were better able to provide facemask ventilation using an ergonomically designed mask than with a traditional facemask. We conclude that better hand position facilitating improved mask seal and less operator fatigue account for our findings.