Manikin‑based noninferiority simulation study of Airgency™: A novel automatic bag valve mask device for emergency respiratory support

Abstract

OBJECTIVES: This study evaluated the performance of Airgency™, an automated bag valve mask (BVM) ventilation device developed by Institut Teknologi Bandung and Padjadjaran University, Indonesia, using a manikin-based simulation model. Its performance was compared with conventional hand-squeezed bagvalvemask ventilation performed by medical professionals, with a focus on reducing operator-dependent variability and fatigue.

METHODS: A manikin based simulation was conducted using an adult airway trainer connected to a lung simulator (ASL5000) set to mimic apneic respiratory failure with normal lung mechanics. The Ambu bag, connected to 15 L/min oxygen, was secured to the manikin. Airgency™ operated in normal mode (tidal volume [VT] 400 mL, 15 bpm) for 30 min, repeated 50 times. Seventy eight anesthesiology residents performed manual BVM ventilation under identical conditions after standardized training. Breathing rate (BR), VT, and peak inspiratory pressure (PIP) were recorded every minute, whereas fatigue was rated using the Visual Analog Scale for Fatigue (VAS F, 1–10).

RESULTS: Airgency&trade, demonstrated superior ventilation stability. BR remained consistent (14.77 ± 0.08 vs. 16.54 ± 7.05 bpm; P < 0.0001), with much lower variability (coefficient of variation [CV] 0.47% vs. 46.1%–121.2%). VT delivery was steady (397.8 ± 3.1 vs. 406.9 ± 85.4 mL; P < 0.0001; CV 2.2% vs. 13.9%–25.7%), and PIP was more uniform (29.4 ± 0.9 vs. 23.1 ± 8.2 cmH₂ O; P < 0.00001; CV 2.5% vs. 28.3%–41.1%). Operator fatigue increased progressively during manual ventilation (VAS F 1.83–5.09; P < 0.0001).

CONCLUSION: Airgency™ maintained consistent, precise ventilation with minimal variability and eliminated operator fatigue, supporting its potential as a reliable alternative to manual BVM ventilation in emergency care.

How to cite this article: Sudjud RW, Aviani JK. Manikin‑based noninferiority simulation study of Airgency™: Anovel automatic bag valve mask device for emergency respiratory support. Turk J Emerg Med 2026;26:205-16.

This study was approved by the Research Ethics Committee of Padjadjaran University [Amendment No. 557/UN6. KEP/EC/2020. Clinical trial registration was not required, as the study used a manikin‑based simulation with medical professionals serving only as operators, and outcomes focused solely on device performance, not human health.

Reza Widianto Sudjud: Conceptualization, Resources, Methodology, Data Curation, Writing – Review and Editing; Jenifer Kiem Aviani: Writing – original draft, Writing – Review and Editing, Visualization, Formal Analysis.

The authors declare that Airgency™ was developed by research teams at Institut Teknologi Bandung and Padjadjaran University. Although the authors are affiliated with these institutions, they have no personal financial interests, ownership, or commercial affiliations related to the device. The study was conducted solely for academic and scientific evaluation purposes.

None.

The authors express their sincere gratitude to Ruli Herman Sitanggang, MD (Anest.), M.PH, Ike Sri Redjeki, MD (Anest.), M.PH, Ph.D., Erwin Pradian, MD (Anest.), M.PH, Ph.D., Suwarman, MD (Anest.), M.PH, Ph.D., Nurita Dian Kestriani, MD (Anest.) from Department of Anesthesiology and Intensive Care Therapy, and Gilang Yubiliana, DMD, M.PH, Ph.D. from Department of Dentistry, Padjadjaran University, Bandung, Indonesia for their valuable contribution during data acquisition process.