Improving the neonatal mask ventilation skills of non-airway experts using the "Five Breath Method": A simulation study.

Trainees in several medical disciplines are expected to achieve competence in neonatal resuscitation. Managing the neonatal airway requires faculties in mask ventilation. Many trainees, however, have limited clinical experience with this skill. An algorithmic method incorporating the steps an airway expert would use for neonatal mask ventilation was designed. The goal of teaching this system, the "Five Breath Method," is to assist trainees with learning and incorporating the steps of neonatal mask ventilation into clinical practice. We hypothesized that for pediatric residents, participating in a teaching session on the Five Breath Method would significantly decrease the time to achieve ventilation ("air entry") in a resuscitation scenario. A pilot study was completed on the Five Breath Method with 23 pediatric residents as subjects. Training in the Five Breath Method reduced the time required to achieve air entry using a neonatal simulator. Subjects required 57 [29-149 and 13-180] seconds (median [interquartile range and minimum-maximum]) before the teaching session and 16 [10-35 and 8-60] seconds after learning the Five Breath Method; Z = -4.11, and P < 0.001. For the 14 of the original subjects who were able to participate in the follow-up study 2-5 months later, 24 [22-38 and 12-69] seconds (median [interquartile range and minimum-maximum]) were required to achieve air entry in the identical experimental scenario. This showed an improvement in time to air entry when compared to that before training; Z = -2.42, and P = 0.01552. This study showed that as little as 10 min of training could drastically improve skills. Learning the Five Breath Method also led to retention of skills over time.