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Original Research

Open Access

A special face mask with integrated angle meter to optimize the head position for bag-valve-mask ventilation—a prospective simulated proof-of-concept study

  • Fabio Schumacher1
  • Natalia Oberhanss1
  • Peter Paal2
  • Urs Pietsch3
  • Wolfgang Wetsch4
  • Volker Wenzel1,5
  • Holger Herff6,*,

1Department of Anesthesiology, Intensive Care Medicine, Pain Therapy and Emergency Medicine, Klinikum Friedrichshafen, 88048 Friedrichshafen, Germany

2Department of Anesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University Salzburg, 5010 Salzburg, Austria

3Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St Gallen, 9000 St Gallen, Switzerland

4University of Cologne, Department of Anesthesiology and Postoperative Critical Care Medicine, University Hospital of Cologne, 50937 Cologne, Germany

5Department of Anesthesiology, University of Florida, Gainesville, FL 32610, USA

6Department of Anesthesiology, PAN Clinic, 50667 Cologne, Germany

DOI: 10.22514/sv.2024.023 Vol.20,Issue 3,March 2024 pp.1-6

Submitted: 13 September 2023 Accepted: 02 November 2023

Published: 08 March 2024

*Corresponding Author(s): Holger Herff E-mail:


The supine position in unconscious patients resulted in the tongue falling back because of the loss of muscle tension which obstructed the upper airway. The head reclination opened the airway, however unexperienced rescuers faced difficulties in performing bag-valve-mask ventilation as it was hard to detect the optimal head position for opening the airway. The bag-valve-mask ventilation could be optimized if it indicated an optimized head angle to the rescuer. A digital sensor was attached to the face mask for measuring the degree of head reclination. Moreover, the face mask was equipped with an airway trainer and sealed via adhesive tape. The airway trainer was connected to a test lung and ventilated through pressure-controlled standard anesthesia machine (Pmax = 10 mbar, Positive End Expiratory Pressure (PEEP) = 0 mbar, f = 12/min). The head of airway manikin was tilted to 42 degrees starting from neutral position with a gradient of 2 degrees. The primary endpoint was the correlation of preset angles and digitally measured head position angles via the mask. In addition, the tidal and minute volumes were evaluated based on the head reclination. The preset and the digitally measured head position angles depicted correlation (R2 = 0.9895855684; p < 0.001). The tidal volume was 150 mL in head position angle of <10 degrees, 200 mL at 18 degrees, 450 mL at 25 degrees, and it levelled with about 500 mL at 30 degrees. In conclusion, digital head position angle was measured to detect the correct head position. A signal in the face mask could indicate the optimized head position to the first respondents or inexperienced rescuers in emergency ventilation.


Airway obstruction; Emergency ventilation; Face mask; Head reclination; Unprotected airway; Ventilation

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Fabio Schumacher,Natalia Oberhanss,Peter Paal,Urs Pietsch,Wolfgang Wetsch,Volker Wenzel,Holger Herff. A special face mask with integrated angle meter to optimize the head position for bag-valve-mask ventilation—a prospective simulated proof-of-concept study. Signa Vitae. 2024. 20(3);1-6.


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