From the Guidelines
Bag-valve-mask (BVM) ventilation by two operators is a technique used in emergency situations where a patient is unable to breathe on their own, requiring the collaboration of two people to ensure effective ventilation.
Key aspects of two-person BVM ventilation
- This technique is preferable when personnel are available and may be more effective than ventilation by a single rescuer, especially in cases of significant respiratory distress 1.
- Two-person technique allows for a better seal of the mask and more controlled and constant pressure on the bag, reducing the risk of respiratory insufficiency or other complications.
- One rescuer uses both hands to open the airway and maintain a tight mask-to-face seal, while the other compresses the ventilation bag, with both observing the chest to ensure chest rise 1.
- It is essential to avoid delivering too high a tidal volume that may contribute to excessive ventilation 1.
- Two-person BVM ventilation should optimize mask seals and minimize contact with respiratory secretions, especially in situations like influenza epidemics or mass disasters 1.
From the Research
Definition of Bag-Valve-Mask (BVM) Ventilation by Two Operators
- BVM ventilation is a fundamental airway management skill for Emergency Medical Services (EMS) clinicians, which involves manual ventilation using a self-inflating bag device paired with a facemask 2.
- Two-person BVM ventilation is a technique where two rescuers work together to provide ventilation, with one person holding the mask and the other person squeezing the bag 3, 4.
Benefits of Two-Person BVM Ventilation
- Two-person BVM ventilation provides greater mean tidal volumes per weight and peak pressures compared to one-person technique 4.
- It allows for more effective ventilation, with higher median expired tidal volume percentages compared to one-handed techniques 5.
- Two-person technique is recommended for initial resuscitation in cardiopulmonary arrest, as it delivers adequate tidal volumes for resuscitation 3.
Techniques for Two-Person BVM Ventilation
- Different techniques have been studied, including the E-C, Thenar Eminence, and modified 2-handed techniques 6, 5.
- The Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique was found to be more effective for novice participants 6.
- Both 2-handed and modified 2-handed techniques resulted in higher ventilatory tidal volumes compared to 1-handed technique 5.
Recommendations for BVM Ventilation
- All EMS clinicians must be proficient in bag-valve-mask ventilation, and BVM ventilation should be performed using a two-person technique whenever feasible 2.
- Rescuers should use available techniques and adjuncts to achieve optimal mask seal, improve airway patency, and optimize delivery of the correct rate, tidal volume, and pressure during manual ventilation 2.