ORIGINAL ARTICLE Efficacy and user preference of two CO 2 detectors in an infant mannequin randomized crossover trial G. A. Hawkes & B. J. O’Connell & V. Livingstone & C. P. Hawkes & C. A. Ryan & E. M. Dempsey Received: 22 April 2013 / Accepted: 28 May 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Assessment of effective ventilation in neonatal mask ventilation can be difficult. This study aims to deter- mine whether manual ventilation with a T-piece resuscitator containing an inline CO 2 detector (either a Pedi-Cap® CO 2 detector or a Neo-StatCO 2 <Kg® CO 2 detector connected to a facemask) facilitates effective positive pressure ventilation compared to no device in a mannequin study. Paediatric and neonatal trainees were randomly assigned to determine which method they began with (no device, Pedi-Cap or a Neo-Stat). The participants used each method for a period of 3 min. They were video-recorded to determine the amount of effective ventilations delivered and the overall percentage efficiency of each method. Efficacy of ventilation was determined by comparing the number of manual venti- lations delivered with the number of times chest rise was observed in the video recording. There were 19 paediatric trainees who provided a total of 7,790 venti- lations, and 93% were deemed effective. The percentage of effective ventilations with the T-piece resuscitator alone, the PediCap and the NeoStat were 90, 94 and 96%, respectively. The difference was greatest in the first minute (T-piece resuscitator alone 87.5%, PediCap 94%, NeoStat 96%). Two thirds preferred the Neo-Stat. The use of a CO 2 detector improves positive pressure ventilation in a mannequin model, especially in the first minute of positive pressure ventilation. The Neo-Stat CO 2 detector was the preferred device by the majority of the participants. Keywords Colorimeter . CO 2 detector . Mask ventilation . Neonates . Pedicap . Neostat Abbreviations NRP Neonatal Resuscitation Program IPPV Intermittent positive pressure ventilation ETT Endotracheal tube CUMH Cork University Maternity Hospital HORIZ Horizontally attached CO 2 detector VERT Vertically attached CO 2 detector TPR T-piece resuscitator SHO Senior House Officer Background The Neonatal Resuscitation Programme (NRP) provides guidelines for neonatal resuscitation procedures [7] and has been shown to be effective in improving neonatal and infant outcomes [2, 3, 12, 15]. Effective positive pressure ventila- tion is a key component of neonatal resuscitation. Intermit- tent positive pressure ventilation (IPPV) is indicated when the infant is apneic or ineffectively breathing, has a heart rate of less than 100 beats per minute or remains cyanotic despite supplemental oxygen [7]. It can be difficult to assess the level of chest wall movement during PPV in a clinical set- ting, particularly in small infants [9]. When delivering IPPV via a facemask, leak of 33% of assumed tidal volume that is provided can occur in a mannequin model [11]. In order to confirm effective ventilation during resuscitation, the NRP currently recommends observing for an increase in heart rate, seeing or auscultating chest inflation and observing for a rise in oxygen saturation level (SpO 2 )[7]. G. A. Hawkes : C. A. Ryan : E. M. Dempsey (*) Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland e-mail: gene.dempsey@hse.ie G. A. Hawkes : V. Livingstone : C. P. Hawkes : C. A. Ryan : E. M. Dempsey Department of Paediatrics and Child Health, University College Cork, Cork, Ireland B. J. O’Connell Department of Biomedical Engineering, Cork University Maternity Hospital, Cork, Ireland Eur J Pediatr DOI 10.1007/s00431-013-2057-9