Mouth-To-Mask Rescue Breathing and Comparisons of Personal Resuscitation Masks

by Gerald M. Dworkin
Printed in Winter 1987 Rescue Squad Quarterly

Because of the major health concerns today, there is a major reluctance among emergency service personnel to perform direct mouth-to-mouth rescue breathing on an unknown victim. When confronted with a resuscitation emergency, response personnel do not always have the luxury of using a resuscitation unit, which would be carried on a fire engine or in a police car. Even if the equipment is available, we can’t always wait to obtain the equipment before resuscitation efforts are begun.

The 1985 National Conference on Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC)recommended that all pre-hospital care providers (i.e. police, fire, lifeguard personnel, etc.) be trained to administer mouth-to-mask rescue breathing. This recommendation was made as a result of the major health concerns regarding AIDS and other communicable diseases.

When used correctly, mouth-to-mask rescue breathing provides the same tidal volume as mouth-to-mouth rescue breathing, and is easier to use and provides larger tidal volumes than the bag-valve-mask technique, since both hands of the rescuer can be used to maintain airway patency and a secure mask fit. In addition, their recommendations included the following:

“A well-fitting mask is an effective, simple adjunct for use in artificial ventilation (rescue breathing) by appropriately trained personnel. The mask should have the following characteristics: transparent material, capability of fitting tightly on the face, and availability in one average size for adults…”

There are presently a variety of personal resuscitation masks which are available for mouth-to-mask rescue breathing, including the Laerdal Pocket Mask, the Respironics Mask, the Rondex Mask, and the Samaritan Mask. However, most masks cannot be used during one-rescuer CPR because they require the rescuer to perform rescue breathing using a jaw thrust maneuver while positioned at the top of the victim’s head. Probably the easiest personal resuscitation mask to use is the new Samaritan Mask developed by The MedTech Group, Inc.

The Samaritan is constructed of a transparent contoured pliable material that is designed to be placed over the victim’s mouth and nose. The mask is fitted with a one way duck valve that is inserted into the victim’s oral cavity. The duck valve, in combination with flexible built-in offsets on the inferior surface of the mask, provides diversion of the victim’s exhaled gas towards the periphery of the mask and away from the rescuer.

The rescuer administers rescue breathing by the conventional techniques by positioning himself alongside the victim’s head and opening the victim’s airway using the head-tilt/chin-lift maneuver. The rescuer applies his/her mouth directly over the valve aperture and exhales through the valve to ventilate the victim. The use of this mask allows the rescuer to provide rescue breathing alone, or in combination with chest compressions in the performance of CPR, and may be used during both single rescuer and team-rescue CPR.

The Laerdal, Rondex, and Respironics personal resuscitation masks are excellent devices for mouth-to-mask rescue breathing. However, additional training is required on the part of the rescuer in order to perform the jaw-thrust maneuver during rescue breathing. And, because the rescuer must position himself at the top of the victim’s head, he/she cannot use the mask in order to perform one rescuer CPR. Nevertheless, the procedure to ventilate the victim is virtually the same for any mask, once the patent airway is established. All masks are available with one-way valves which allow the exhaled air from the victim to be diverted away from the rescuer. The major difference between the masks is their compactness for carrying and storage, and the required positioning of the rescuer during the use of the mask.

The advantages of carrying and using a personal resuscitation mask by pre-hospital care providers are many. The rescuer does not have to make direct mouth-to-mouth contact with the victim; the rescuer does not inhale the victim’s exhaled air; and saliva is not exchanged between the victim and the rescuer.