Mouth-to-mask ventilation: a superior method of rescue breathing

Tidal volumes achieved using endotracheal intubation with a self-inflating bag were compared to those achieved with the esophageal obturator airway, a bag-valve mask system, and mouth-to-mask ventilation in an experimental model employing 18 unskilled and 4 partially skilled rescuers. When compared to mean tidal volumes achieved with endotracheal intubation (1,193 ml with unskilled, 942 ml with semi-skilled rescuers), ventilation with the bag-valve-mask system was significantly less (509 and 495 ml tidal volumes) and was, in fact, well below the value of 800 ml recommended for rescue breathing. Mouth-to-mask ventilation produced tidal volumes (1,093 ml and 1,200 ml) not significantly different from those seen with endotracheal intubation. If clinical findings confirm these experimental results, mouth-to-mask ventilation should replace the bag-valve-mask system in the initial management of respiratory arrest.