Master the BVM

Why is it important to be proficient with the BVM?  Because inevitably we will all have patients that are difficult to intubate, but if we can ventilate these patients with the BVM we can buy ourselves time to use our alternative techniques. If you can’t ventilate effectively with the BVM you find yourself in a “can’t intubate, can’t ventilate” situation severely limiting your time and options.

So what’s the best way to BVM? We all know the classic C-E technique allowing you to hold the mask with one hand and squeeze the bag with the other. This will get you by in some patients, but in others it will be impossible to get a tight seal. You can try a double C-E, but there is a better option. Instead, ventilate with a two thumbs down technique. Place both thumbs parallel along the lateral margins of the mask, then wrap all 8 fingers along the angle of the jaw and pull the patients face up into the mask, adjusting your thumb pressure to seal any leaks. Have an assistant squeeze the bag, or if you’re on your own you can position the bag between your arm and body and squeeze it that way.

If you’re not already using this technique try it next time you have to bag a patient. I think you’ll find it much easier to create a seal and more fatigue-resistant (and it’s supported by evidence – And don’t forget your oral and nasal airways!


  1. This is fantastic! Thanks Eric.

    Sometimes we forget to ask for help, and airway is no exception. You can always “outsource” tasks that help you better care for your patient. Giving anyone the ambu-bag and instructing them to squeeze with one hand every 6 seconds is a very simple way to allow you to focus on the seal and the angles associated with good ventilation!

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