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BVM ventilation is the primary method for providing active ventilatory support (Figure 3.1). The key BVM device components include a self‐inflating bag, oxygen reservoir, and conforming facemask. The primary indications for BVM ventilation include hypoventilation (inadequate respiratory drive or effort) or frank apnea.

The technique of BVM ventilation can be challenging, requiring rescuers to open the airway and maintain a mask seal with one hand while squeezing the ventilation bag with the other hand. Seasoned clinicians often recommend performing BVM using two people, with one rescuer opening the airway and holding the mask with both hands and the other squeezing the bag [2]. Two‐handed BVM techniques provide greater tidal volumes than one‐handed techniques [3]. Several studies have demonstrated the difficulty of performing effective BVM ventilation, particularly in a moving ambulance or during prolonged resuscitation efforts. This is one of the motivations for advanced airway interventions for many prehospital patients [4].

An important potential adverse effect associated with BVM ventilation is gastric insufflation, which may result in regurgitation and aspiration of gastric contents into the airway. While some anesthesiologists use Sellick’s maneuver (cricoid pressure) to minimize gastric insufflation during operating room BVM ventilation, a multicenter, blinded, randomized controlled trial of 3,500 operating room patients found no benefit from the technique [5–9].

Figure 3.1 BVM ventilation