Which of the following is the most reliable indicator of adequately performed bag-valve mask ventilations in an apneic adult with a pulse?

• A. Twenty breaths/min being delivered to the adult
• B. Decreased compliance when squeezing the bag
• C. Consistently increasing heart rate
• D. Adequate rise of the chest when squeezing the bag

Answer: (D)

During bag-valve-mask ventilation of an apneic adult with a pulse, the most reliable sign that you’re ventilating adequately is seeing the chest rise with each squeeze. That visible chest movement confirms that air is entering the lungs and delivering a tidal volume sufficient to exchange gases. Simply aiming for a certain rate, such as twenty breaths per minute, doesn’t ensure adequate ventilation and can even lead to over-ventilation. Resistance or changes in bag feel reflect mechanics of bag compression but don’t prove effective ventilation. A rising heart rate can be influenced by many factors and isn’t a dependable immediate indicator of ventilation success. So the chest rise is the best cue that ventilation is being performed effectively.