Safety. Less Stress. Efficiency.Saving lives with ventilators

2 Saving lives with ventilators

Advantages of ventilators

• Volumeandpressurecontrol:Constantventilationrate,

precisevolumedeliveryandexactcompliancewithpressure

limits

• Controlfunctionviamonitoringoftheventilation

parametersandvisualandacousticalarms

• Thestrainofmechanicalworkisreduced

• Themaskcanbepositionedtightlyusingtwohands

• Resourcesarefreedupforotherlive-savingactivities

• CPRmodefacilitatesguideline-compliantcardiopulmonary

resuscitation

• Morepreciseandconvenientapplicationofassistedforms

of ventilation

• Simplifiedandsaferventilationofspecialpatientgroups

• Avoidanceofhypoventilationandhyperventilationthanks

toprecisesettingandmonitoringoptions

Mechanicalventilation:abetteralternative

Mechanical ventilation is a safe method not just for patients

butalso foryouas theuser.Theventilators fromWEINMANN

Emergencyhavebeenthoughtthroughdowntothefinestdetail

andoffermaximumsecurityforemergencyventilation.Theycan

beusedinallareasofemergencymedicine:fromtheventilation

of narcotized patients at the scene of the emergency and

patienttransfersbetweenhospitalsthroughtocardiopulmonary

resuscitation.

RapidAssistance

Circulatory arrest, respiratory disease, poisoning and severe

trauma – thanks to emergency ventilation from Emergency

MedicalServiceprofessionals,everydaythousandsofpeopleget

asecondchanceatlife.Rescueteamsareoftenunderalotof

timepressure.Stressandsignificantphysicalandpsychological

strainarepartoftheireverydayworkinglives.Afterall,whenitis

amatteroflifeanddeath,everymovemustbespoton.

Ifapatientstopsbreathingorthere isariskoftherespiratory

musclesbecomingfatigued,breathingmustbemanagedeither

manuallywitha resuscitatorormechanicallywitha ventilator.

Thegoal:Toensurethegasexchangeinthelungsandkeepthe

airwaysfreeinordertosupplytheorganswiththeoxygenthey

needtosurviveandtoexpireCO2.

3Saving lives with ventilators

Risksofbag-valve-maskventilation

Doyouprefertousearesuscitatorandmaskoveraventilator?

Do you feel more confident when you are able to take the

patient“intoyourownhands”?

Studiesconfirmthatbag-valve-maskventilationoftenposesmore

risks thanbenefits. This isbecause it is technicallydemanding

and requires a lotof skill and training. EvenexperiencedEMS

professionalsarenotalwaysabletoventilatepatientsexactlyas

prescribedbyinternationalguidelines1.Thesedemandconstant

ventilationvolumesandtheavoidanceofpressurepeaksinthe

airways.Theseoftenfluctuategreatlywithmanualventilation2.

Andiftheventilationparametersaren’tcorrect,theresuscitator

doesnotissueanalarmasisstandardwithventilators.

Wheretheriskslurk

• Hypoventilationasaresultofthemasknotbeingfitted

tightly

• Riskofaspirationfromstomachoverinflation

• Barotraumawithpressurepeaksfromexcessivelyfast

volumedelivery

• Hyperventilationfromincorrectventilationrate

• Differentlysizedrespiratoryvolume

1 EllingR,PolitisJ:Anevaluationofemergencymedicaltechnicians'abilitytousemanual ventilationdevices.AnnEmergMed1983Dec;12(12):765–82 LeeHMetal.:Canyoudeliveraccuratetidalvolumebymanualresuscitator? EmergMedJ2008;25:632–6343 DeakinCDetal.:EuropeanResuscitationCouncilGuidelinesforResuscitation2010. Section4.Adultadvancedlifesupport.Resuscitation2010Oct;81(10):1305–52

PatientSafety

TwoEMSprofessionalsarerequired

Thereisalsotheriskthatitmaynotbepossibletofitthemask

tightlyonthefacewithonehand.Thiscanresultinreductions

intheventilationvolume,so-calledleakage,whichcanbelife-

threatening for patients. This is why international guidelines

recommendthetwo-workertechnique3:Thefirstteammember

positionsthemasktightlyonthepatient’sfacewhilstthesecond

memberoperatestheresuscitator.Thedisadvantage:Twopeople

aretiedup.

4 Saving lives with ventilators

4StallingerAetal.:Effectsofdecreasinginspiratoryflowrateduringsimulatedbasiclifesupportventilationofacardiacarrestpatientonlungandstomachtidalvolumes.Resuscitation2002Aug;54(2):167–73

Risk:OverinflationoftheStomach

Preventingaspiration

Ventilationwitharesuscitatorandmaskisnotalwayssufficient.

This is why too much volume is often delivered. This is not

withoutitsrisks:Overpressurerapidlybuildsupandtheriskof

stomachoverinflation increases. This can lead to regurgitation

andaspirationofthestomachcontents!

With mechanical ventilation this risk is reduced. This was

confirmedby a study on amanikinwith simulated circulatory

arrest4:Whilstthelungtidalvolumewascomparable,thestomach

tidal volumewithmechanical ventilationwasconsiderably less

thanwithmanualventilation.

Withaventilationpressure>approx.

20mbar(dependingonthecase)

overpressurebuildsupandthestomach

isoverinflated!

Asaconsequenceofstomach

overinflation,thecontentsofthe

stomachareregurgitatedwhichcould

causetheairwaystobecomeblocked.

Thereisariskofsuffocationaswell

astheoftenfataldelayedeffect,

aspirationpneumonia.

Caution,aspiration!

Withaventilationpressure<approx.

20mbar(dependingonthecase)airis

guideddirectlyintotheairways.

Stomach

Stomachcontents Diaphragm

Lung

Esophagus

Trachea

5Saving lives with ventilators

5TurkiMetal.:Peakpressuresduringmanualventilation.RespirCare2005Mar;50(3):340–4

Risk:LungDamage

Avoidingpressurepeaks

Excessively high ventilation pressures can lead to overinflation

ofthepulmonaryalveoliandtriggerbarotraumaorvolutrauma.

Giventhelackofmonitoring,thereisnopressurecontrolwith

manualventilation.Pressureisdeliveredbyinstinct.Thisresults,

inpart, inconsiderablyhigherpeakpressuresthanaventilator

would generate5. Moreover, EMS professionals use different

techniques–andthusapplymoreor lesspressuretothebag.

Withventilators,ontheotherhand,thereisintegratedpressure

limitationtoavoidpressurepeaks.

Highriskofoverpressure withmanualventilation:

• Highplateaupressures(barotrauma)

• Highshearforces(atelectrauma)

• Progressiveoverinflation(volutrauma)

• Inflammation(biotrauma)

Ventilatorsguarantee:

• Avoidanceofpressurepeaksthanks

tointegratedpressurelimitation

• Pressurecontrolthankstomonitoring

• Uniformpressuredelivery

Alveoli

Traumatizedalveoli

Ventilator

Resuscitator

6 Saving lives with ventilators

Maintainingtherightrate

HyperventilationisaneverydaychallengeforallEMSprofessionals.This ishardlysurprisinggiventhatoverlyhighventilationrates

reducethelikelihoodofsurvival.Thiswasconfirmedbyastudyofout-of-hospitalemergencieswithcardiacarrestandmanualbag

ventilation conducted in theUSA6. The EMS professionals hyperventilated almost all patients –with fatal consequences.On the

backofthis,scientistssimulatedthisobservationonpigssufferingfromcardiovascularfailure.Theresult:Almostallanimalssurvived

ventilationwith12strokesperminute.Incontrast,virtuallyallthepigswhoweretreatedwith30strokesperminutedied.Thehigher

theventilationrate,thelowerthecoronaryperfusionpressure.

6AufderheideTP,LurieKG.:Deathbyhyperventilation:acommonandlife-threateningproblemduringcardiopulmonaryresuscitation.CritCareMed2004Sep;32(9Suppl):S345–51

Risk:Hyperventilation

Excessiveventilationduetohighventilationrateandhighminutevolume

Elevatedintrathoracicpressure

Loweredcoronaryperfusion Loweredcerebralperfusion

Reducedsurvivalrate

7Saving lives with ventilators

Bloodgases“outofkilter”

Duringtransportationinparticularitisdifficulttomaintaintherightventilationrate.Accordingtoastudy,thiscanbedemonstrated

withthebloodgasvalues7:InthecaseofmanuallyventilatedpatientstheCO2partialpressurefell,thepHvalueincreasedandpatients

experiencedrespiratoryalkalosis,yetwithmechanicallyventilatedpatients,theacid-basebalanceessentiallyremainedstable.

7HurstJMetal.:Comparisonofbloodgasesduringtransportusingtwomethodsofventilatorysupport.JTrauma1989Dec;29(12):1637–40

Hyperventilation

Vasodilationpossible inthebody

pCO2

Respiratoryalkalosis

Exacerbationofhypotension(dropinbloodpressure)

Vasoconstriction inthebrain

ShiftoftheO2bindingcurvetotheleft

Reducedtissueoxygenation(thesupplyofoxygento thetissueisimpeded)

Reducedintercerebralcirculation(resultinginhypoxiaofthebrain)

8 Saving lives with ventilators

PossibleAirwayAccess

Ventilationmask e.g.laryngealmask Endotrachealtube

Intubationisnotabsolutelynecessary

There isnodoubtthat intubation is thegoldstandardwithmechanicalventilationas itprotectsagainstaspiration.However,safeintubationinpreclinicaltreatmentisassociatedwithrisksandfailedattemptswithextendedhypoxiatimesarenottheexception.ThisiswhymanyEMSprofessionalscontinuetooptforalternatives.Ifyouwishtoavoidintubation,butstilldesirecontrolledventilation,youcanalsouseourventilatorswithlessinvasivetechniquessuchasalaryngealmask,laryngealtubeorventilationmask.

Risk:AirwayAccess

Whetheraventilationmask,supraglotticairwayaidsoranendotrachealtube,selectthetypeofairwayaccesswhichisbestsuitedtoyourpatientandthespecificemergency.ItgoeswithoutsayingthattheventilatorsfromWEINMANNEmergencyarecompatiblewithallthreetypesofairwaymanagement.

9Saving lives with ventilators

PatientSafety

Onthesafeside

Incontrasttomanualventilation,mechanicalventilationoffers

keyadvantages,particularlywithregardtopatientsafety8:

• Ifthepatientisventilatedusingamask,theEMSprofessional

canholdtheheadinacorrectaxialpositionwithbothhands

• Theriskofoverlyintensiveventilationwithhyperventilation

isavoidedasonlytheventilatorisabletoguaranteeconstant

andguideline-compliantventilation

• As there are reduced peak pressures, the intrathoracic

pressureisalsolower.Thisimprovesthevenousreturnand

thecardiacoutput.Furthermore,overinflationofthestomach

becomeslessfrequent–theriskofaspirationisreduced.8DeakinCDetal.:EuropeanResuscitationCouncilGuidelinesforResuscitation2010. Section4.Adultadvancedlifesupport.Resuscitation2010Oct;81(10):1305–529DockeryWKetal.:Acomparisonofmanualandmechanicalventilationduring pediatrictransport.CritCareMed1999Apr;27(4):802–6

A safe arrival

Intermsofpatienttransport,too,mechanicalventilationbeats

manual ventilation. This was confirmed by a comparative

study: With manual ventilation the ventilation parameters of

intubated patients during intra-clinic transportation fluctuated

moresignificantlythanwithmechanicalventilation9.Moreover,

with ventilators the interruptions associated with bag-valve-

mask ventilation, for exampleduring transportation innarrow

staircases,areavoided.

10 Saving lives with ventilators

SimpletechnologyTheventilatorsfromWEINMANN

Emergencyareeasytouse:Emergency

modesandsettingofthegenderand

heightofthepatientofferrapidaccess

tothecorrectparametersettings.

UserSafety

Freeyourheadandyourhands

NotonlypatientsbutalsoyouasanEMSprofessionalbenefit

frommechanicalventilation.Afterall,ventilatorsofferenhanced

safety:Visual andacousticalarms, clearly visiblemeasurement

andsettingparametersaswellasconstantventilationparameters

ensure the guideline-compliant and consistent ventilation of

patients.SomeofthedevicesfromWEINMANNEmergencyalso

feature special functions such as voice prompts, metronome

andCPR*andRSI**modes.With theMEDUtrigger individual

mechanicalbreathscanbetriggeredmanuallyonthemask.This

enablesyoutodeterminethetimingofmechanicalbreathsvery

precisely.

Makingthebestuseofresources

Mechanicalventilationalsorelievesstrain,andnotjustfroman

ergonomic perspective:Whilst manual ventilation ties up one

oreventwoEMSprofessionals,withmechanicalventilationof

intubatedpatientsyouhavebothhandsfreeforotherimportant

tasks. Valuable personnel resources can be put to the best

possibleuse– this improves theworkflowdecisivelyand frees

upresourcesforotherlive-savingmeasuresordocumentation.

* cardiopulmonaryresuscitation**rapidsequenceinduction

Argumentsinfavorofmechanicalventilation:

• Compliancewithinternationalguidelines

• Constantventilationrate

• Precisevolumedelivery

• Pressurelimitation

• Comprehensivevisualandacousticalarmfunction

• Optimumtightpositioningofthemaskusingtwohands

• Thestrainofmechanicalworkisreduced

• Resourcesarefreedupforotheractivities

Argumentsagainstbag-valve-maskventilation:

• Riskofhypoventilationorhyperventilationduetoincorrect

ventilation rate

• Dangerofpressurepeaksifvolumeisdeliveredtooquickly

• Ventilationvolumescanfluctuate

• Noalarmfunction

• Atleastonehandisrequiredforbagcompression

• Mechanicaloperationistiringonlongtransportroutes

• Itisonlypossibletouseonehandtopositionthemaskora

secondrescueworkerisnecessary

• Tiesuptheresourcesofmanyhighly-qualifiedpersonnel

TheFactsataGlance

Ventilatororbag-valve-maskventilation? Maketherightdecision!

11Saving lives with ventilators

Improvedcontrolwithventilators

Ventilatorsguaranteetherightventilationrateandkeepthisconstant.Dependingontheventilationform,theventilationpressure/

volumearealsoconstantoraremeasuredanddisplayed.Thismeanshyperventilationandhypoventilationareavoided.Hypoventilation

isoftenaconsequenceofbag-valve-maskventilationasthemaskisnotpositionedtightlyonthefacewithjustonehand.

Ventilators

VariousdifferentiatedventilationformsIntuitivestartscreen Innovativeemergencymode

MEDUMATEasyCPR

WithMEDUMATEasyCPRadevicehasbeendevelopedspecifically

for emergency ventilation during and after resuscitation. An

exampleofthisistheoptionofmanuallytriggeringmechanical

breaths directly at the mask. The ventilator issues clear voice

instructions to ensure maximum safety and guide the user

throughresuscitation.

MEDUMATEasyCPRisintuitivetooperate,smallandtherefore

easytotransport.

MEDUMATStandard2

MEDUMAT Standard² offers a whole new take on modern

ventilation.Itsmoststrikingfeature:amonitorwithalargecolor

display.Thisshowsallkeyrespiratoryvaluesquicklyandclearly.

83321-EN-06-2016©Copyrightreserved.DuplicationofanykindcanonlybeundertakenwiththeexpresspermissionofWEINMANNEmergency.Subjecttoanyprintingerrorsaswellaschangesintechnologyanddesign.

SimplyProfessional

WEINMANNEmergencyisafamily-owned,internationallyactivemedicaltechnologycompany.Withourmobilesystemsolutionsforemergency,transportanddisastermedicine,wesetstandardsforsavinghumanlives.Inclosecollaborationwithprofessionalusersin emergencymedical services, hospitals andmilitarymedical corps,we develop innovativemedical products for ventilation anddefibrillation.Formorethan100yearswehaveofferedourcustomersahighdegreeofreliability,extensiveexperienceandqualitymadeinGermany.

MadeinGermany WEINMANN-Emergency.comSimplyProfessional

Germany WEINMANNEmergency MedicalTechnologyGmbH+Co.KG Frohbösestraße12 22525HamburgGermany T: +4940881896-0 Reception F:+4940881896-480 Reception T: +4940881896-120 CustomerService T: +4940881896-122 After-SalesServiceE:info@weinmann-emt.de Center for Production, Logistics, Service WEINMANNEmergency MedicalTechnologyGmbH+Co.KG Siebenstücken14 24558Henstedt-Ulzburg Germany

China Weinmann(Shanghai)MedicalDeviceTradingCo.Ltd. T: +862152302225•info@weinmann-emt.cn France WEINMANNEmergencyFranceSARL–Paris-Igny T: +33169415120•info@weinmann-emt.fr Russia WeinmannSPbGmbH–St.Petersburg T: +78126333082•info@weinmann-emt.ru Singapore WeinmannSingapurPTE,Ltd. T: +6565094430•sales-singapore@weinmann-emt.de Spain WEINMANNEmergencyMedicalTechnologyGmbH+Co.KG T: +34917901137•sales-spain@weinmann-emt.de