Laerdal Infant Resuscitators are Unreliable as Free-Flow Oxygen Delivery Devices

ABSTRACT

Laerdal Infant Resuscitators (Laerdal Medical Co., NY) are commonly used as free-flow oxygen delivery devices during neonatal resuscitation in situations where oxygen but not mechanical ventilation is desired. This study evaluates the performance of these resuscitators as free-flow oxygen devices. Efficiency was measured by comparing oxygen flow entering the resuscitator to oxygen flow delivered by the re-suscitator. Clinical impact was assessed by measuring simulated patient f_iO₂. Three randomly selected resuscitator bags were tested for oxygen delivery efficiency by comparing oxygen inflow to outflow over an inflow range of 1 to 15 liters per minute (Ipm). Measured outflow was 18-24% of inflow, demonstrating that as much as 82% of the oxygen flow escapes via the safety air inlet, safety blow-off valves, and other leaks. With the patient valve assembly removed, efficiency improved to 53-59%. Simulated f_iO₂ ranged from 0.23 to 0.68 at 5 Ipm oxygen flow. We conclude that use of the Laerdal Infant Resuscitator for the delivery of free-flow oxygen, even with the valve assembly removed, generates highly variable patient f_iO₂. The use of self-inflating bags for delivery of oxygen without manual ventilation should be reconsidered.

Keywords

Resuscitation - oxygen - infant/newborn - Laerdal Resuscitator - ventilator