Bag-Mask Ventilation (BMV) is a manual method used to deliver breaths to a patient who cannot breathe adequately on their own. This technique employs a self-inflating bag connected to a face mask to push oxygenated air into the lungs, providing life support in emergencies. The effectiveness of this process relies exclusively on achieving a perfect, airtight connection between the mask and the patient’s face. Without a secure barrier, the positive pressure intended to fill the lungs leaks out, resulting in insufficient air delivery. Mastering the specific hand placement and pressure necessary for this seal is paramount to successful manual rescue breathing.
The Standard Single-Rescuer Seal Technique
The most widely taught method for a single rescuer to secure the mask is known as the “E-C clamp” or “C-E grip” technique. The rescuer positions themselves directly at the patient’s head for optimal leverage and control over the face and airway. Using the non-dominant hand, the thumb and index finger form the “C” shape, applying gentle pressure to the mask dome to press it onto the face. The remaining three fingers curl under the bony prominence of the patient’s jaw, forming the “E” shape.
The “E” portion of the grip lifts the jaw upward toward the mask, bringing the face to the mask. This prevents pushing the mask down, which can inadvertently obstruct the airway. Pressure must be applied strategically: firm enough to prevent air leakage, but not so forceful that the jaw closes and blocks the air passage. The mask apex should be placed over the bridge of the nose, with the base fitting between the lower lip and the chin, ensuring both the mouth and nose are fully covered.
Combining Seal Technique with Airway Maneuvers
Achieving a perfect mask seal is only one step, as the tongue and other soft tissues can still fall back and block the upper airway, nullifying the ventilation effort. To counter this common obstruction, the mask seal must be paired with specific airway-opening maneuvers.
Head-Tilt/Chin-Lift Maneuver
For patients without a suspected neck or spinal injury, the Head-Tilt/Chin-Lift maneuver is performed while maintaining the C-E grip. This involves tilting the head back slightly while the E-fingers simultaneously lift the chin. This action effectively moves the tongue away from the back of the throat and opens the air passage.
Jaw Thrust Maneuver
When a spinal injury is a possibility, the Head-Tilt/Chin-Lift maneuver must be avoided to prevent further damage. In this trauma scenario, the rescuer utilizes the specialized Jaw Thrust maneuver to open the airway. This technique requires placing fingers behind the angles of the patient’s lower jaw and pushing the jaw forward, displacing the mandible without moving the head or neck. The C-E grip is adapted or maintained to hold the mask in place while the Jaw Thrust is executed, ensuring the seal remains intact.
The Advanced Two-Rescuer Seal Method
When personnel are available, the two-rescuer technique is the preferred method for Bag-Mask Ventilation, as it significantly improves the reliability of the seal. This approach allows one rescuer to dedicate both hands entirely to securing the mask and maintaining the airway, while the second rescuer manages the ventilation bag. The primary mask holder stands at the patient’s head and uses a “double E-C clamp” technique.
In this two-handed method, the thumb and index finger of both hands form two “C” shapes over the mask. The remaining fingers of both hands form two “E” shapes underneath the jawbone. This bilateral application of force maximizes the upward lift on the jaw, which is crucial for opening the airway and seating the mask firmly. The two-handed method provides a stronger, more symmetrical, and leak-proof seal, which is beneficial for patients difficult to ventilate due to factors like facial hair or anatomical variation.