Bag-mask ventilation can be performed by one or more providers. The American Heart Association teaches the "E-C clamp technique" if only one provider is present. In this technique the provider places the mask with the narrow part resting on the bridge of the nose. Then with one hand, the provider grips the mask with the webbing between their thumb and first finger resting on top of the mask. The other three fingers are placed along the mandible allowing for a chin lift (in patients with no risk for c-spine injury) and jaw thrust. The mask should fit tightly to the face with no air leak.
If two airway providers are available then the two handed technique can be used. This method has been shown to provide better airway seal, decreased provider fatigue and increase total effectiveness of ventilation (greater minute ventilation and tidal volumes). This technique is similar to the one-handed method, but allows one provider to place both hands on the mask and grips on the mandible while the other provider can focus on delivering the breaths via the bag.
In both techniques the provider holding the mandible should take care to avoid compressing the soft tissue of the neck as this may lead to worsening airway obstruction.
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A two-handed jaw-thrust technique is superior to the one-handed "EC-clamp" technique for mask ventilation in the apneic unconscious person.
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Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children.
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