It takes two: development of simulation training for two-handed neonatal mask ventilation integrating a respiratory function monitor; a non-randomised before-and-after simulation study.

Introduction: Facemask leak is common with a one-handed hold and can reduce the efficacy of neonatal resuscitation. Our objective was to assess a standardised, respiratory function monitor (RFM)-guided training intervention for two-handed neonatal positive pressure ventilation (PPV). Methods: Development of a two-handed PPV training algorithm occurred through an iterative process with learner and expert feedback. Participants performed PPV via a facemask on a term manikin with feedback from the RFM display (Monivent Neo100). We first piloted the training intervention on ten clinicians over six sessions. The intervention was then assessed through a before-and-after, non-randomised simulation-based study, blinded to the RFM, comparing mask leak, tidal volume and participant feedback. Mask hold style and hand preference were recorded. Results: Prior to the intervention, 17/40 (42%) had previously used two-handed PPV in clinical practice. Forty clinicians were included in the training study. Mask leak was significantly lower with a two-handed hold before training: one-handed median 27%, (IQR 3-73%) vs two-handed: 2.5% (1-31%), Conclusion: Effective facemask ventilation in a neonatal manikin was associated with a two-handed hold without training or prior clinical experience. After training facemask leak was low with both holds. Feedback indicated increased participant preference for two-handed PPV after training.