S36 ANNALS OF EMERGENCY MEDICINE 37:4 APRIL 2001 RESCUE BREATHING AND BAG-MASK VENTILATION Panel Members: Volker Wenzel, MD* Ahamed H. Idris, MD ‡ William H. Montgomery, MD § Jerry P. Nolan, MD II Michael J. Parr, MD ¶ Gail E. Rasmussen, MD # Wanchun Tang, MD** ‡‡ James Tibballs, MD §§ Lars Wik, MD II II From Department of Anesthesiology, Leopold-Franzens-University, Inns- bruck, Austria*; Department of Emer- gency Medicine, University of Florida, Gainesville, FL ‡ ; Department of Anesthesiology, University of Hawaii Straub Clinic, Honolulu, HI § ; Depart- ment of Anaesthesia, Royal United Hospital, Bath, United Kingdom II ; Department of Intensive Care, Liver- pool Hospital, University of New South Wales, Sydney, Australia ¶ ; The Meridian Anesthesiology Group, Meridian, MS # ; Institute of Critical Care Medicine, Palm Springs, CA**; Department of Anesthesiology, Uni- versity of Southern CA, Los Angeles, CA ‡‡ ; Intensive Care Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia §§ ; Department of Anesthesiology, National Norwegian Hospital, Oslo, Norway. II II Supported in part by the American Heart Association, Dallas, Texas. Reprints of single articles are available online at www.mosby.com/AnnEmergMed for $35 per article. Address for correspondence: Volker Wenzel, MD, Leopold-Franzens- University, Department of Anesthesiology, Anichstrasse 35, 6020 Innsbruck, Austria; E-mail volker.wenzel@uibk.ac.at. Joint copyright © 2001 by the American Heart Association and the American College of Emergency Physicians. 0196-0644/2001/$35.00 + 0 47/0/114128 doi:10.1067/mem.2001.114128 [Wenzel V, Idris AH, Montgomery WH, Nolan JP, Parr MJ, Rasmussen GE, Tang W, Tibballs J, Wik L. Rescue breathing and bag-mask ventilation. Ann Emerg Med. April 2001;37:S36- S40.] INTRODUCTION Before the conference, international experts and members of the Basic Life Support (BLS) Subcommittee of the American Heart Association agreed that current recom- mendations for tidal volume (for both mouth-to-mouth and bag-valve–mask ventilation) and a universal com- pression-ventilation ratio during cardiopulmonary resuscitation (CPR) should be reviewed because of new evidence published since 1992. Furthermore, there was concern that the current practice guideline for relief of foreign body airway obstruction (FBAO) in victims who are found unconscious was difficult for the lay rescuer to learn and retain and required a disproportionate amount of time to teach. 1992 GUIDELINES 1 The 1992 guidelines recommend a tidal volume of 800 to 1,200 mL given over 1.5 to 2 seconds for mouth-to- mouth ventilation and a tidal volume of 10 to 15 mL/kg (700 to 1,050 mL in an adult weighing 70 kg) given over 2 seconds for bag-valve–mask ventilation. The Heimlich maneuver (termed subdiaphragmatic abdominal thrusts or abdominal thrusts before 1976) is included in the steps of BLS for victims who are found unconscious. The compression-ventilation ratio for 1-rescuer CPR is 15:2 (15 chest compressions at a rate of 80 to 100 per minute, followed by 2 rescue breaths). For 2- rescuer CPR, the ratio is 5:1 (5 chest compressions at a rate of 80 to 100 per minute, followed by 1 rescue breath). Rescue Breathing and Bag-Mask Ventilation