Bag-Valve-Mask Ventilation: Two Rescuers are Better than One: Preliminary Report.

Jesudian MC, Harrison RR, Keenan RL, Maull KI Critical Care Medicine 1985 Vol. 13 Pages 122-123

Noting that the Bag-Valve-Mask (BVM) is used in most hospitals to initiate cardiopulmonary resuscitation, the authors express some doubt that the BVM can deliver a tidal volume sufficient for resuscitation. This study used 10 senior medical students who had recently completed the American Heart Association ACLS course. Each participant was asked to deliver at least 1,000 ml tidal volumes for 5 consecutive breaths 1) using a BVM directly connected to an endotracheal tube, 2) in the usual single rescuer manner in the unintubated patient, and 3) where two rescuers used the BVM; one using both hands to hold the mask and maintain the airway, while the other used both bands to squeeze the bag. Mean tidal volumes were 962 +/- 28 (SD) ml through the ETT, 592 +/- 78 ml with a single rescuer, and 1131 +/- 53 ml with two rescuers. This study suggests that the BVM used by a single rescuer with minimal training fails to deliver adequate tidal volumes for resuscitation. When two rescuers use the BVM, tidal volumes are more than recommended and are comparable to those seen with endotracheal intubation. Two explanations are offered: First, two hands can more effectively seal the mask to the face so that less delivered tidal volume is lost. Second, two-handed compression of the BVM increases delivered tidal volume. The authors conclude that two person BVM ventilation should be considered for initial resuscitation in cardio-pulmonary arrest, and adequacy of ventilatory efforts should be evaluated frequently during cardiopulmonary resuscitation.