So, just to be perfectly clear, as I have heard this in a round-about way from a few sources... We are not to use high concentration/High Flow oxygen via a BVM with a VSA patient without inserting an SGA - so when treating a VSA pt, we go directly to the SGA without ever using an OPA or NGA, correct? And what are our options if the SGA fails after 2 attempts and we do not have any extra hands to ensure a tight seal on the BVM mask - do we ventilate at all, or just administer compressions and carry on?
The latest recommendations from OBHG (here) have now changed. The new recommendations are to avoid oxygen delivery rates ‰¥ 16L/min via non-rebreather mask or BVM and to withhold manual ventilation in any spontaneously breathing patient unless severe hypoxia (Sp02 <85%) is not improving with other therapies.
With regards to a patient who is VSA, you can manually ventilate and give oxygen with flow rates <16L/min until you are able to insert the advanced airway. We recommend using the lowest flow rate that allows for the reservoir bag to fill.
If after 2 unsuccessful SGA attempts, you would then continue to provide as tight a seal as you are able and manually ventilate using a flow rate <16L/min.