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Effects of training time and feedback on ventilation skills in lay rescuers
  1. Peter Paal1,
  2. Markus Falk2,
  3. Elisabeth Gruber3,
  4. Werner Beikircher3,
  5. John Ellerton4,
  6. Hartmann Kainz1,
  7. Volker Wenzel1,
  8. Hermann Brugger5
  1. 1Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
  2. 2Inova Q Inc., Bruneck, Italy
  3. 3Department of Anesthesiology and Critical Care Medicine, General Hospital Bruneck, Bruneck, Italy
  4. 4Mountain Rescue Council, England and Wales, Pinfold, Nicholson Lane, Penrith, Cumbria, UK
  5. 5Mountain Rescue Service provided by the South Tyrolean Alpine Association, President of the International Commission for Mountain Emergency Medicine, Bruneck, Italy
  1. Correspondence to Dr Peter Paal, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria; peter.paal{at}


Objective Lay rescuers have difficulties acquiring ventilation skills during training. Non-feedback manikins are still widely employed, although skill acquisition is suboptimal. We analysed if a longer training time and verbal feedback, given by an instructor, improved ventilation skill acquisition with non-feedback manikins.

Methods Forty-three high school students without prior medical training participated in this prospective randomised trial. Under one-to-one instructor guidance, 25 volunteers were trained on a manikin with a mouth-to-mask device for 10 min, and 18 volunteers for 20 min. After training, volunteers were assessed and verbal feedback was given: ventilate more if the mean tidal volume <0.5 L, ventilate less if >0.7 L or ventilate the same for 0.5–0.7 L. The volunteers were then reassessed.

Results At the assessment, tidal volume, minute volume, peak airway pressure, ventilation rate and stomach inflation rate were comparable between the 10 and 20 min groups. After verbal feedback, at reassessment both groups increased tidal volume (assessment 0.75±0.24 vs reassessment 0.80±0.16 l/min; p=0.007), minute volume (9.1±3.0 vs 10.0±2.4 l/min; p=0.001), peak airway pressure (17.0±5.2 vs 18.3±3.4 cmH2O; p=0.003) and stomach inflation rate (67 vs 88%; p=0.02), while ventilation rate (12.3±2.1 vs 12.6±2.3 ventilations/min; p=NS) remained comparable.

Conclusions Both 10 and 20 min ventilation training times resulted in comparable skills. Volunteers hyperventilated the manikin and produced excessive stomach inflation in this model. This increased even further after verbal feedback.

  • Basic life support (BLS)
  • cardiopulmonary resuscitation (CPR)
  • mouth-to-mask resuscitation
  • tidal volume
  • training
  • ventilation
  • airway
  • resuscitation
  • ventilation

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  • Funding Laerdal, Norway.

  • Competing interests Mouth-to-mask ventilation devices were provided by Laerdal, Stavanger, Norway. Laerdal did not have any role in study design, in the collection, analysis and interpretation of data, in the writing of the manuscript and in the decision to submit the manuscript for publication. No author has any financial or personal relationship with other people or organisations that could influence this work.

  • Ethics approval This study was conducted with the approval of the Bozen, Italy.

  • Provenance and peer review Not commissioned; externally peer reviewed.