Can you use an ambu (ambu bag) while giving cardiopulmonary resuscitation (CPR) to a patient?

Yes, You Should Use an Ambu Bag (BVM) During CPR

Yes, bag-valve-mask (Ambu bag) ventilation is a fundamental component of CPR and should be used to deliver rescue breaths during cardiopulmonary resuscitation. 1

How to Integrate BVM Ventilation with CPR

Without an Advanced Airway (Standard CPR)

• Deliver 2 breaths during a brief pause after every 30 chest compressions using the 30:2 compression-to-ventilation ratio 1, 2
• Each breath should be given over 1 second with a tidal volume of approximately 500-600 mL (6-7 mL/kg) to produce visible chest rise 1, 2
• The pause for both ventilations should be brief, approximately 3-4 seconds total 2
• Use an adult (1-2 L) bag to deliver the appropriate tidal volume 1

With an Advanced Airway (Endotracheal Tube or Supraglottic Device)

• Switch to continuous chest compressions without pauses 1, 2
• Deliver 1 breath every 6-8 seconds (8-10 breaths per minute) asynchronously with compressions 1, 2
• Continue compressions at a rate of at least 100 per minute without interruption for ventilations 2

Critical Technical Points

Two-Person Technique is Strongly Preferred

• One rescuer uses both hands to maintain the airway and mask seal while the other squeezes the bag 3, 4
• This technique is significantly more effective than single-person BVM ventilation 3, 4
• For a lone rescuer during CPR, mouth-to-barrier device techniques are preferred over single-person BVM due to difficulty maintaining adequate seal 3

Oxygen Supplementation

• When supplemental oxygen is available, use maximal feasible inspired oxygen concentration during CPR 1
• The BVM can be used with room air (21% oxygen) if oxygen is not immediately available—never delay ventilation while searching for oxygen equipment 3
• For optimal oxygen delivery (60-95%), attach an oxygen reservoir with flow rates of at least 15 L/min for adult bags 3

Critical Pitfalls to Avoid

Excessive Ventilation Causes Harm

• Avoid hyperventilation—this is a Class III recommendation (harm) by the American Heart Association 1, 2, 4
• Excessive ventilation increases intrathoracic pressure, decreases venous return to the heart, and diminishes cardiac output and survival 2, 4, 5
• Use only enough force to produce visible chest rise 1, 2, 3
• Ventilation at high respiratory rates (>25 breaths per minute) is common during resuscitation but should be avoided 1

Minimize Interruptions in Compressions

• Aim for a chest compression fraction of at least 60% 2
• Prolonged interruptions in chest compressions should be avoided during advanced airway placement 1
• During the early minutes of sudden cardiac arrest, chest compressions are more critical than ventilations because arterial oxygen content remains adequate initially 2

Avoid Mechanical Ventilators During Active CPR

• If a patient on mechanical ventilation develops cardiac arrest, disconnect from the ventilator and switch to manual BVM ventilation 5
• Modern mechanical ventilators erroneously sense chest compressions as spontaneous breathing triggers, delivering inappropriately high respiratory rates 5
• Manual ventilation allows proper synchronization with the compression phase at the correct rate of 10 breaths per minute with an advanced airway 5

Special Considerations

Automatic Transport Ventilators (ATVs)

• During prolonged resuscitative efforts, pneumatically powered, time- or pressure-cycled ATVs may allow the EMS team to perform other tasks while providing adequate ventilation 1
• This is a Class IIb recommendation (may be reasonable) 1
• Always have a bag-mask device available for backup 1
• Avoid using the automatic mode of oxygen-powered, flow-limited resuscitators during CPR as they may generate high positive end-expiratory pressure that impedes venous return 1

Monitoring Ventilation Quality

• Watch for visible chest rise with each breath to ensure adequate volume 2, 3, 4
• Monitoring respiratory rate coupled with real-time feedback during CPR may result in better compliance with ventilation guidelines 1