6.1 Two-Rescuer Bag-Mask Ventilation & E-C Clamp

6.1 Two-Rescuer Bag-Mask Ventilation & E-C Clamp

Bag-mask ventilation requires two things at the same time: an open airway with a sealed mask and a controlled squeeze that produces chest rise. When two trained rescuers are available, dividing those tasks usually makes ventilation more effective.

Prepare the equipment

Choose a mask that fits from the bridge of the nose to the cleft of the chin without covering the eyes. Connect supplemental oxygen when it is available and within the response protocol, and make sure the bag, valve, and reservoir are assembled according to the device instructions. Do not postpone needed breaths because an oxygen source is not yet attached; a self-inflating bag can still deliver room air.

Position the patient supine. Use a head-tilt/chin-lift when trauma is not suspected. With suspected cervical injury, begin with a jaw thrust, but establish an airway with a head-tilt/chin-lift if the jaw thrust is ineffective.

Rescuer 1: airway and mask seal

The airway rescuer stands at the patient's head and places the mask over the nose and mouth. With each hand:

• The thumb and index finger form the letter C around the edge or connector area of the mask and press the cushion against the face.
• The middle, ring, and little fingers form the letter E along the bony mandible and lift the jaw into the mask.

The emphasis is lift, not simply downward pressure. Pulling the jaw forward helps open the airway and seats the face into the mask. Keep fingertips on bone; pressing into the soft tissue under the chin can push the tongue and soft tissues backward.

For an infant, maintain a neutral or slightly extended head position rather than the greater extension used for an adult.

Rescuer 2: controlled ventilation

The second rescuer squeezes the bag smoothly over about 1 second and watches the chest. Stop squeezing when visible chest rise occurs, then release the bag so it refills and the patient exhales.

Do not empty the bag or use a memorized fraction of bag volume. Bag sizes and patient sizes differ. Visible chest rise is the practical endpoint taught in BLS.

The ventilation rescuer also counts the correct interval:

• Adult with a pulse but inadequate breathing: 1 breath every 6 seconds.
• Infant or child with a pulse but inadequate breathing: 1 breath every 2-3 seconds.
• CPR without an advanced airway: 2 breaths after the appropriate compression count.
• CPR with an advanced airway: 1 breath every 6 seconds for an adult or every 2-3 seconds for an infant or child, without pausing compressions.

If the chest does not rise

Use a short troubleshooting sequence:

1. Reposition the head and re-open the airway.
2. Re-seat the mask and increase the jaw lift.
3. Confirm that the mask size is appropriate.
4. Check the bag-valve connections and that the bag can refill.
5. Look for a visible foreign body when the airway is opened; remove only what is seen.
6. Use suction or an airway adjunct only when available, trained, and authorized.

Do not compensate for a leak by squeezing faster or harder. That can force air into the stomach without improving lung ventilation.

Integration with compressions

Without an advanced airway, the compressor pauses after 30 adult compressions, after 30 one-rescuer pediatric compressions, or after 15 two-rescuer pediatric compressions. The airway team gives 2 breaths and signals the compressor to restart. Keep the pause under 10 seconds.

With an advanced airway, compressions continue while the ventilation rescuer gives breaths at the age-appropriate interval. The team watches for excessive ventilation and maintains compressor rotation.

Common errors

• Choosing a mask that covers the eyes or extends below the chin.
• Pressing down with both hands without lifting the jaw.
• Placing fingers in the soft tissue under the mandible.
• Emptying the bag on every breath.
• Continuing to squeeze despite no chest rise without repositioning.
• Pausing compressions for breaths after an advanced airway is in place.

For the exam, two-rescuer bag-mask ventilation means one rescuer devotes both hands to the airway and mask seal while the second gives controlled breaths to visible chest rise.

Communication during troubleshooting

The two rescuers should describe what they observe instead of silently increasing force. Useful statements include “no chest rise,” “repositioning the head,” “improving the jaw lift,” and “checking the connection.” After a correction, the ventilation rescuer reports whether rise is present. This closed loop makes bag-mask care a coordinated skill and allows the compressor or team leader to know whether oxygenation is effective without creating an extended pause.