The CPR mask thread

I'm interested in getting a supply of CPR masks for my EDC, backpack as well as for the car and home kits.

I searched, and while there are a number of threads that mention CPR masks, I thought it would be worthwhile to have one thread where we could collect information specifically on this topic.

I'd be interested in features discussed.

I'd be interested in hearing about specific makes and models.

Interested in sources.

To get things started, I'm assuming the primary desirable features are a one way valve and filter?

I'm a bit fuzzy how compact such a model can actually be.

In any case, please give your thoughts.

Thanks much,

-john

My vote is for the Dynarex CPR Face Shield through Dixie EMS Supply Company (Brooklyn, NY). You can't really beat the price either at $1.58 each, and Dixie has great customer service (and all their telephone sales reps are certified EMT's).

Jim

I've asked numerous EMRs ad EMTs both civilian and military and the concensus seems to be that their mouth won't go anywhere near somebody elses unless they have a mask with a one-way valve.

It only takes once to catch something nasty...and not everything can be cured once you get it. Not to mention the fact that I can't imagine what it would be like to get some vomit funneled into your mouth through a mask that doesn't have a valve...that's reason enough for me.

AMBU Life-Key on the key-chain: http://www.ambu.com/RespiratoryCare/Respiratory_Care.aspx?GID=GROUP51&ProductID=PROD871

Leardal (or similair) Pocket-Mask for large kit's and bags: http://www.laerdal.com/document.asp?subnodeid=8695273

And MDI Microshield for everything in between: http://www.mdimicrotek.com/prod_cpr-microshield.htm

The only mask I can comment on from personal use is the Laerdal Pocket Mask. It is kinda big and clunky for EDC, unless you EDC a fair sized bag of some kind, but it works, and works well. If you happen to have an O2 bottle handy, you can hook the line up to a port in the mast and blow more O2 into the victim. Before they added the one way valve I saw a victim vomit into the mask; once the CPR'r got out of the way it looks like Mt. Vesuvius in Technicolor. I have several different brands of little bitty CPR masks that I carry around with me, but I have luckily never had to use one. And rule number one in the wonderful world of CPR is to NEVER EVER perform bareback CPR on anyone but a family member...

IMHO, it's time to get the cpr masks out of the first aid kit.

The american heart association standard currently seems to be hands only CPR-apparently the alternating chest compression and relaxation cycle moves some air in the lungs and may be more effective than the 15 compressions/2 breaths version.(http://handsonlycpr.eisenberginc.com/resources.html)

The thing is, what you want between you and the patient is distance and fluid-proof barriers, not a plastic device that puts your face 4 inches from the patient. Transmission of body fluid born pathogens can occur with saliva or...well...any of the rest of the body fluids contacting the eyes, or areas of broken skin. Chest compressions cause aerosol dispersion of body fluids. ER optimists wear gloves, masks and goggles: pessimists add tyvek jumpsuits and hepa respirators and are usin ambu bags or mechanical ventilators, so the provider's face is well away from the patients face.
It is way too easy acquire a bloodborne disease even in the controlled environment of the hospital, even when the providers know the risks and have the protective equipment available to them. Trading rescuers lives for patients lives is not a good bargain.

I wouldn't chuck that mask just yet, if you are really interested in possible life saving. As I understand it, the hands only thing only applies if you see the victim go down. If you stumble on one who is already down, full CPR is still the way to go. And yes, it can be dangerous. If you are in a uniform of any kind, you are pretty much committed to start. No uniform, you have to make the decision. Tearful family members of the victim can make it hard to walk away.

But I didn't read the whole link, so I might have missed something...

Are you aware the Ambu website actually lists this item as available by prescription only?

Jim

Why the heck would a CPR mask be by Rx only? (yes, I see it, I just don't understand)

-john

Also for those of us who have CPRO (CPR for the preoffesional rescuer) We are actually told not to do compression only cpr, but I would like to have an BVM myself, Also about the rx facemask, I was wondering the same thing, maybe it means you have to have certification??

John,

I have several, all of which are different brands. Since I have only had to perform CPR in the back of an ambulance, or in the patients home and have had "full resuscitation" equipment, I have not had to use my pocket masks at any time. I do know the Laerdal masks are designed to actually fit an adult size BVM.

My primary carry pocket kit when on ambulance duty is the MDI rescue holster, which is found on the same website as Jim mentioned, just scroll down. I use the gloves from it with every patient contact and then replace them. I modified the contents of the holster when I noticed after a couple of years or so the mask was "splitting" from age. I put in the Laerdal key chain mask in a zip lock baggie and then added a small bottle of Purell. I actually have two pairs of gloves in the holster as one pair may rip, or you actually have to double glove.

Gloves in these kits (unless they are vinyl) should be replaced often as they deteriorate from age.

Take care,

Stargazer

Really? Not over here it isn't

I just "mock-ordered" the AMBU life key at a web site and it didn't say anything about having a prescription right before the "submit order" button is pushed.

maybe it's just a fluke kind of thing, does anyone want to email them and find out?

I'm an EMT-Intermediate, I work part time for a 911-only EMS system and I have done CPR for real. I have been the 2nd man on many ACLS calls (drugs, manual defib, 12-lead EKG, etc). Some points:

1) the little fold-up shields are definitely better than nothing, but if you're doing rescue breathing on your own (no BVM) I prefer the Laerdal pocketmask (or equivalent) with the 1-way valve. I keep a foldup shield on my person and a pocketmask in my bags/kits.

2) the AHA implemented compression-only CPR not because no one ever needs breaths but because untrained bystanders were avoiding doing any resuscitation at all due to valid fears of infection. The AHA has found that uninterrupted compressions are more important than breaths, so they figured compressions alone was better than nothing. If you have any decent training, however, you should include breaths and that leads to bullet point number 3...

3) cardiac arrest is NOT the only reason you may need to provide rescue breaths. Head injury, lightning strike, near drowning and overdoses are situations where the victim might have a pulse but their respiratory drive has been short circuited. Some properly-applied rescue breathing can potentially save their life.

"Coming back from the dead" after cardiac arrest is rare. Coming back after respiratory arrest is not as rare. It would be a shame if you couldn't provide those critical breaths.

Just as it is with so many of the things we discuss here: knowledge and training are more important than equipment selection. But when it comes to equipment, get the best you can carry.

Your local American Red Cross chapter offers a variety of CPR masks, from keychain masks to masks with oxygen inlets.

I have a couple of keychain masks and a couple of full sized ones. I have never had to use either yet, but I can vouch for their quality.

-Kurt

I don't want to slow the discussion, but I thought I'm mention that I ordered a couple of the Laerdal Pocket Masks for my wife and I.

Thanks for all the great discussion and recommendations so far.

-john

One thing that may be interesting, that I have already mentioned, is that if you take CPR for the professional rescuer, then they give you a ambu rescue mask, which you could use in one of your kits.

Oh also JohnN, from were did you order the pocket masks?

Interesting. My wife isn't a care provider, but does manage a medical clinic and she is taking the hands-on portion of their lifesaving course today. Be interesting to see if they get freebies.

I didn't ask details, this thread caused me to ask her about compression-only CPR, and she indicated they were not allowed to do compression-only CPR.

So what about practice with your mask? Would practice impact the performance of your mask? In other words, any reason not to use the mask while attending a class? What about sanitation, etc.?

Thanks,

-john

We used to have to clean and re-use our pocket masks after use ('til they made the mistake of putting me in charge of ordering, then we suddenly had a lot of them o hand), we were told to just wash them out with soap and water, then spray with a disinfectant spray...

The mask itself can be cleaned as follows (instructions are usually printed on the packaging):

wash with warm water and soap. Flush with clean water. Then dunk it into a solution of 1 part bleach to 64 parts of water for 10 minutes. Flush again with clean water and let it air-dry.

The one-way valve can be used repeatedly on training with a manikin, but it needs to be replaced after use on a real person.


Perhaps it's better to order a mask specifically for training purposes and one for 'real' use? Their not THAT expensive..

The only reason that you have to replace the masks after the real person is because they have their secretions and vomit on them correct? You aren't really worried about the one way valve part however. Please if I am wrong let me know!

Correct, but also because they breathed (sp?) into the mask. The mask itself is easy to clean, but cleaning the one-way valve would be unpractical and possibly damaging to the valve itself. Therefor the valve is a disposable item.

But is it still ok to use the valve I used in training?

We do chest compressions only now 200 in a row. Seems to work better, esp. with an AED.

CPR had less than a 2% success rate in survival to hospital, compression-only is closer to 6%

"...CPR had less than a 2% success rate in survival to hospital, compression-only is closer to 6%..."

That is very interesting. Do you do compression only even if you do not see the victim go down???

OBG, some EMS systems are playing with compression-heavy CPR. I believe Arizona and Minnesota both have systems that are doing the 200 cycle/ 2 breaths (IIRC) cpr. I've seen resus. rates approaching 10-20%, but that might just be biased stats. Anyone can play with those... for example, this past year I've had a 100% resuscitation AND discharge from hospital CPR rate. Of course, I've only had 1 arrest....

As for the masks, Climberslacker, YES, you can reuse it from class. Once a real patient has used it, toss it. Even though you can sterilize them, it's like $12 for a new one. I personally wouldn't want to carry a vomit/blood/saliva filled CPR mask back to my house just to save a few bucks.

All the masks here have been OK. Personally, I carry a keychain mask with a valve in my backpack, and a BVM in my car FAK. I've already had enough traumatic arrests where a pocket mask would have had blood all over my face (gotta "love" facial trauma). I'll keep my distance, thank you very much.

"...I've only had 1 arrest..."

Lucky guy, I never had an arrest (well, not the kind of arrest we are talking about here). What I had was a whole bunch of closed head injuries (and other nasty trama), with long eta's on the ambulance, so I am batting a thousand. I lost them all...

Thanks MDinana, thats what I thought, just wanted to double check, I know this sounds a bit morbid, but now that I've learned this stuff I really want to do CPR on someone...anyone else have this feeling after learning cpr, or am I just a sick twisted person??

"...I really want to do CPR on someone..."

You have to keep in mind that, depending on the circumstances, you might not be able to save the victim. Then you have to live with that. Some people have a real hard time with that. Luckily (I guess), I am not one of those. And you can get real tired if you have to do it long enough. I have done full blown CPR, all by myself, for over 30 minutes in the past, and I was really tuckered...

yep

Well, you're in luck. I've posted this link in the past, but you can get your own mini CPR training dummy from the American Heart Association for $30. It's supposed to click when you've compressed the sternum the proper distance so you get used to pushing hard. One common mistake doing CPR is our instinct not to hurt someone so we don't push down hard enough to really compress the heart and squeeze out the blood.

And you can practice with your CPR mask, too, if you'd like.

Former Paramedic, ACLS instructor and CPR instructor here. Lots codes in the past, but currently not working in ems. (I'm LE now.)

Back in the day, this was the best thing going because it was much easier to get a good seal. http://www.allmed.net/catalog/item/87/523

There were many times that it wasn't necessarily easy to get a good face mask seal. There may be something better on the market now. Like I said, I'm a little long in the tooth so there may be newer things available.

As for those little fold up face shield things, I carry one but they are less than ideal. You car or house kit should definitely have a real mask. In a real CPR situation, there are blood, excretions and vomit to deal with. You get some on your gloves then you have to hold that face shield to get a good seal and guess where those fluids are? On the outside of the shield. It's better than nothing but not by much.

thanks! thats super cool!!

That's cool, but he really wants to do real CPR on a real person. Unless I totally misread what he wrote. Dummies are find and dandy for training, but they are far from the real thing, trust me on this...

Yeah I didn't really think about how low the survival rate is, but still it would be cool/sad to have to do it on someone.

It would be cooler to say that you saved him/her. Just be prepared to lose them...

Even if that person would not have survived, it does not look good to just stand there and do nothing.

Jeanette Isabelle

Indeed it does not...

My instructor for CPR told us, I don't know if its true however, that he has arrived on scene (he's an EMT) of a code, only to see two people arguing over whether or not it is 15:2 or 30:2, which is totally stupid!

Indeed it is...

that is what your last two posts in this tread started with!!! LoL

You realize, of course, that he is just going to say, “Indeed they did.”

Indeed..

Indeed I will...

Wow, were not off topic at all, but I'm not really sure that you can talk about CPR masks much more...


indeed

Yep. I've found these to be the best design available, by far. It's pretty hard to NOT get a good seal with these. They can also be used from any angle relative to the patient, from the either side, from above the head, or even astride the patient's torso. This matters because patients often are found in the darnedest places, like wedged firmly between the bathtub and the toilet. They do go a bit flat after a couple of years, but a syringe-full or two of air injected through the sealed air filling port takes care of that.

The much more common design of pocket mask actually requires some good hands-on training before the user is able to reliably achieve a decent seal on most patients, and works best from the head.

Jeff

Very true, Nemoaz. Good point. It also seems that that's about the time you see the big split in your glove...!

Jeez, BTDT. My first arrest in EMS was just that situation.

Try one pinned behind a steering wheel. For real fun, turn the car upside down...

... on a dark rainy night, with muddy ditch water running through the wreck, by the light of a Mini-Mag ...

Jeff

WOW!! Those are some situations that I would'nt like to be in, much less preforming CPR!

That too. We won't even get into spilled gasoline, sparks from downed power lines, etc etc etc...

CPR was invented in Viet Nam, and spread stateside as military docs returned to the world. The American Heart Association began promoting CPR as a public service, and it rapidly turned into a major revenue source for them in providing the trainer certification, workbooks, and all the rest of the stuff that goes along with it. I learned CPR before AHA started the program, and have been duly recertified every couple of years for 3 decades, and the AHA guidelines have changed each time, as they should . AHA guidelines always lag a bit behind the research in CPR, cuz AHA guidelines are approved by a committee, and approval becomes political.
Latest example: 'The "new CPR" — developed at the University of Arizona — has tripled survival rates for cardiac-arrest patients rescued by Phoenix paramedics, a preliminary study shows.
This is the latest in a mounting body of evidence suggesting that the "new CPR" — doing chest compressions only — can save more lives than the old CPR, which includes mouth-to-mouth breathing.
However, the evidence has not persuaded the American Heart Association — the group that issues national guidelines for cardiopulmonary resuscitation — to fully adopt chest-compression-only CPR for victims of sudden cardiac arrest.'
http://www.azstarnet.com/allheadlines/156249.php

The other complicating factor is that is that the research suggests that less than 4% of the patients resuscitated in the field leave the hospital alive. Of those that survive, more tha 14% have moderate to severe brain damage. http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijrdm/vol4n1/survival.xml

Like most things in life, CPR is complicated. We try to do the right thing. We try to use our skills. We try not to disappoint the family. We try not to be criticized, or sued, by folks who feel that we could have done more. But it is also true that there is a reason that the patient arrested. That reason may (96% of the time) be something that cannot be fixed by medical science. Doing CPR may give them some time to spend with their loved ones, or it may give them a loneger life with permanent brain damage.
We always err on the side of life-honor the do not resuscitate request if your state permits us to do so, but proceed with resuscitation if in doubt. I have participated in resuscitating 95 year old folks with brain cancer-no DNR, no choice. Gotta do it. But also, gotta recognize that, sometimes, resuscitation prolongs death, rather than prolonging life.

"...no DNR, no choice..."

That is why, when you get old, or have a serious medical problem, you get a DNR and post that thing EVERYWHERE...

That news article is from 2006. You'll be pleased to know that the AHA has made the change. I posted about it few months ago here , where you'll find the link to the AHA's new "Hands-only CPR" campaign on their website. Mike, you may be more interested in the link to the AHA's Emergency Cardiovascular Care Committee article in the March 31, 2008 edition of Circulation and reading the nitty-gritty about the change in the journal article.

Has anyone taken a CPR class in the past couple months? Just curious if they have switched the curriculum yet. For various practical reasons--like re-training instructors, using up the old materials and printing new materials, etc.--it could take a pretty long while before people are actually learning the new guidelines.

You kidding? When I hit 70, that sucker is getting TATOOED on my chest, right where the hands have to go. Probably get "No Shock" where the paddles go as well.

NurseMike, certainly feel your pain on those old folks. Folks like that, we're just working because (98% of the time) of selfish family not realizing the obvious.

"...TATOOED on my chest, right where the hands have to go..."

Being just about the only member of my family without a tatoo, that sounds like the one I want.

We did learn something with my mother-in-law, some hospitals will not accept a DNR, and a durable power of attorney, unless they are on that particular hospitals forms. And every hospital has their own forms...

Sounds like y'all are in a hurry to die. The last thing that would keep me awake at night is worrying that someone might SAVE my life.

I need a tatoo that says R?BYA - "Resuscitate? BET YOUR ..."

Having seen more than one close friend or family member lay in an almost vegative state for a long long time, I don't want to go out that way. Quality of life means everything to me...

I'm sorry that you had to go through that with your loved ones, OBG


Just be careful. One day you make an offhand comment to your wife after seeing someone in a wheelchair "I wouldn't want to live that way." Next thing you know, they're telling her "Well, Mrs. Baldguy, if he recovers at all he'll be confined to a wheelchair, but if we just give him a little extra morphine..." A lot of people are in wheelchairs and very happy to be alive at all. I bet a lot of them once said "I'd never want to live that way."

I told my wife I don't ever want her to have to make that kind of decision. I instructed her to tell them to transplant my brain into a jar of nutrient solution if necessary.

Wheelchair I could live with...

I just took the St. John Ambulance basic first aid with CPR C (+ AED) over the weekend.

Their method/technique is currently 30 compressions + 2 breaths for all casualties needing chest compressions (CPR or restricted airway) regardless of age. The only difference is the technique used for infants of course where you use 2 fingers instead of 2 hands for chest compressions.

The instructor wasn't allowed to comment on the new breathless style despite our curiousity as a group of students. For now, I'll be doing it as trained and have already picked up a pocket mask with a one way filter.

"...30 compressions + 2 breaths..."

I wonder what happened to 15:2 and 5:1???

I guess they changed it to make it easier...she wouldn't really talk about that either...just that it's changed and that this is the right way.

I suspect AEDs have a lot to do with it. If you have an AED, you just go nuts until it tells you to stand back...then start when it tells you to start again. If you have to time 30, 15, or 5 compressions in the 2 minutes the AED gives you before hitting them with the juice, it could get confusing.

I understand where they are coming from. People need a reason to live just as a person needs a reason to survive in a survival situation. If a person does not have a reason to survive, they won't.

Jeanette Isabelle

I Agree. A wheelchair is not the end of the world.

Jeanette Isabelle

Not so much in a hurry to die, as aware of the truth that there are things that are worse than death, and that a significant number of the folks who arrest and die, quickly and cleanly, are resuscitated to endure a slow and tortured demise. Most of the folks I know who have worked in intensive care units do not wish to ever wake up in one.

Amen Nursemike.

I think the 15:2 and 5:1 are cut out of the lay CPR. However, IIRC, professional CPR still teaches a higher rate once an airway is established (Combitube, endotracheal, etc). I don't remember if it's 5:1 or what, but that's b/c I haven't had an arrest in the field for probably 3 years. Hospital is different, cuz the respiratory tech is bagging while someone bangs on the chest.

15:2 is for 2 rescuer CPR on an infant or child IIRC, or thats what they taught us in CPRO, i think

Boy, I was taught (and taught as an instructor), 5:1 for infants. Now, I just did some research and see that 30:2 is for EVERYONE. Why can't they leave things the same, us old guys have a hard time learning new stuff...

I did some poking on this and there might actually be some clinical reasoning for it.

Apparently there have been some studies that show the first compressions of CPR don't really do anything by themselves except build up some pressure...blood doesn't actually start to move until the later compressions once that pressure has built up a bit.

I can't find any hard facts unfortunately.

OBG, the bad thing is once you start getting more advanced, it changes, as I said in my last post, its 30:2, unless you are doing 2 rescuer CPR, then it becomes 15:2, but only on an infant and child... Don't listen to me tho, go out and take the class, its really fun!

In the course I took, 2 rescuer CPR was still 30:2.

Note that climberslacker said infant/child 2-person CPR is 15:2. 2-person CPR for an adult stays 30:2, which I assume is what you were being taught, Hacksaw. If not, then that doesn't quite jive with the 2005 standards.

What I was taught is 30:2 for everybody under all conditions, ages, and scenarios, just like OBG mentioned above.

Oh, duh, I forgot one more caveat--lay vs healthcare provider CPR. Lay person CPR is 30:2 for everyone, "professional" CPR splits between 15:2 and 30:2. Hard to keep that straight in my brain. Well, now you can see why regular folks are just taught 30:2 for everyone!

yeah, sorry for confuzuling all the lay responders here (as in the ones who only have CPR or less)

If you look at the algorithms in the Maryland EMS 2008 Protocols on page 45 (55 out of the total number of 348 pages) for Adults (> 8years old) and Page 47 (57 out of the total number of 348pages) for pediatrics (< then 8 years old) you will see that for adult patients (> 8years old) the rate is 30:2 and for pediatrics patients is: 1 rescuer CPR the rate is 30:2 and with 2 rescuer CPR the rate is 15:2

MIEMSS Protocols

Pete

Here's a case where CPR played a big role in a boy's survival. Since he's 14 years old and apparently normally sized, legally he's a child but medically he's an adult.

CPR is often pointless in elderly folks w/ major disease but it can be crucial to survival in other cases.