Mouth-to-Mask Ventilation: Essential Techniques and Guidelines

Mouth-to-Mask Ventilation: A Barrier-Protected Resuscitation MethodMouth-to-Mask Ventilation acts as a specialized form of rescue position, diverging from conventional mouth-to-mouth and mouth-to-nose techniques. This pocket mask position provides a safeguard against infection transmission between the pocket mask rescuer position and the individual in distress. Mastery in CPR protocols and in-depth comprehension of this specialized technique are imperative for successful life-saving actions.

  1. Evaluate the emergency scenario and initiate a distress call to the rescue services.
  2. Stabilize the affected individual in a rescue position, ensuring they are supine on a solid foundation.
  3. Facilitate unobstructed respiration by employing the Head-Tilt/Chin-Lift technique to open the air passage.
  4. Select and align a pocket mask of suitable dimensions over the nose and oral cavity of the casualty.
  5. Establish an airtight interface between the pocket mask and the facial contour to eliminate the possibility of oxygen escape.
  6. Deliver ventilatory support at a frequency of one inhalation every two seconds.
  7. Monitor thoracic elevation and depression post-inhalation to verify the efficacy of the resuscitation.


Step 1: Assess the Situation and Call for Emergency Assistance

Before starting any resuscitation efforts, assess the situation for potential dangers and hazards. Check the victim's responsiveness and breathing. If the victim is unresponsive and not breathing normally, immediately call for emergency medical help or ask someone nearby to do so.

Step 2: Ensure the Victim is Lying on their Back on a Firm Surface

Gently place the victim on their back on a firm and flat surface. Ensure that the area around the victim is clear to allow for effective resuscitation efforts.


Step 3: Open the Victim's Airway Using the Head-Tilt/Chin-Lift Maneuver

Kneel beside the victim's head and place one hand on their forehead and two fingers of the other hand under their chin. Gently tilt the victim's head back with the hand on the forehead while lifting the chin forward with the other hand. This maneuver helps to open the airway and facilitate better airflow during rescue breaths.


Step 4: Choose the Appropriate Size Mask and Position it Over the Victim's Nose and Mouth

Select a transparent face mask that appropriately fits the victim's face. The mask should cover both the nose and mouth of the victim. Place the bottom of the mask over the victim's nose and the top of the mask over their mouth.


Step 5: Create a Seal Between the Mask and the Victim's Face to Prevent Air Leakage

Press down firmly on the mask to create an airtight seal between the mask and the victim's face. The seal is essential to ensure that the rescue breaths are effectively delivered into the victim's airway.


Step 6: Administer Breaths at a Ratio of 1 Breath over 2 Seconds

With the mask in place and a proper seal created, take a normal breath and deliver rescue breaths into the mask over a duration of 2 seconds. Deliver the breaths with enough force to make the victim's chest rise visibly. For adults, the recommended ventilation rate is 12-20 breaths per minute.


Step 7: Observe for Chest Rise and Fall After Each Breath to Confirm Effectiveness

After delivering each rescue breath, observe for the chest to rise and fall as the victim's lungs fill with air and then expel it. This confirms that the ventilation is effectively reaching the victim's lungs.

After each set of rescue breaths, immediately continue with chest compressions. For one-rescuer CPR, the recommended compression-ventilation ratio is 30 compressions to 2 ventilations.

Blood Pressure Category
Systolic (Upper)
Diastolic (Lower)
Health Risks
Less than 120 mm Hg
and Less than 80 mm Hg
Low risk of heart disease or stroke
Maintain healthy lifestyle (diet, exercise, no smoking)
120-129 mm Hg
and Less than 80 mm Hg
Doubled risk of cardiovascular complications
Make lifestyle changes (lose weight if overweight, increase physical activity, limit alcohol)
Hypertension Stage 1
130-139 mm Hg
or 80-89 mm Hg
Increased risk of heart attack, stroke, kidney disease
Lifestyle changes and potentially medication under doctor's guidance
Hypertension Stage 2
140 mm Hg or Higher
or 90 mm Hg or Higher
High risk; can lead to heart failure, vision loss, dementia
Medication required in addition to lifestyle changes as recommended by doctor
Hypertensive Crisis
Higher than 180 mm Hg
nd/or Higher than 120 mm Hg
Immediate danger of life-threatening complications
Seek emergency medical care immediately
Cardiac Arrest
Heart Attack
Sudden loss of heart function, leading to collapse
Blockage in a coronary artery, affecting blood flow to the heart muscle
Interruption of blood flow to the brain, leading to brain damage
Main Cause
Electrical malfunction of the heart
Blockage in coronary arteries
Blockage or rupture of blood vessels in the brain
Circulation Affected
Entire body
Heart muscle
Brain tissue
105Sudden collapse, unconsciousness, no pulse
Chest pain or discomfort, shortness of breath
Sudden numbness or weakness, confusion, trouble speaking or understanding speech/73
Emergency Response
Immediate CPR and defibrillation
Activate emergency medical services, chew aspirin
Activate emergency medical services, FAST assessment (Face, Arms, Speech, Time)
CPR, defibrillation
Thrombolytic therapy, angioplasty, stenting
Thrombolytic therapy, clot retrieval,
Long-term Management
Implantable cardioverter-defibrillator (ICD), medication management
Medication management, lifestyle changes, cardiac rehabilitation
Medication, rehabilitation, lifestyle changes
Dependent on prompt CPR and defibrillation, underlying health conditions
Dependent on extent of heart muscle damage, effectiveness of intervention
Dependent on severity of brain damage, rehabilitation progress
Risk Factors
Previous heart conditions, arrhythmias, electrolyte imbalances
Atherosclerosis, high cholesterol, hypertension, smoking, diabetes
Hypertension, diabetes, smoking, high cholesterol, atrial fibrillation

What is Mouth to Mask Ventilation?

Mouth-to-Mask Ventilation is a method used in CPR and emergency first aid to deliver rescue breaths to a person who is experiencing cardiac arrest or respiratory distress. In this technique, a transparent face mask with a one-way valve is placed over the victim's mouth and nose to establish an airtight seal. The rescuer then delivers rescue breaths into the mask, which allows the oxygen-rich air to enter the victim's airway while preventing the rescuer from inhaling exhaled air or potential contaminants. Key features of Mouth-to-Mask Ventilation include:

  • Transparent Mask: The face mask used in Mouth-to-Mask Ventilation is transparent, allowing the rescuer to observe the victim's mouth and nose for any obstructions or signs of breathing.
  • One-Way Valve: The mask is equipped with a one-way valve that allows air to flow from the rescuer's mouth into the victim's airway but prevents the backflow of air from the victim to the rescuer. This feature ensures that the rescuer is protected from inhaling exhaled air and reduces the risk of cross-contamination.
  • Proper Seal: The rescuer must position the mask properly over the victim's mouth and nose to create an airtight seal. This ensures that the rescue breaths are effectively delivered to the victim's lungs.
  • Universal Applicability: Mouth-to-Mask Ventilation can be used on victims of all ages, including infants, children, and adults. Rescuers can adjust the mask size accordingly to fit the victim's face.


What is the Purpose of Mouth to Maks Ventilation?

The primary purpose of Mouth to Mask Ventilation is to oxygenate the victim's lungs, restore respiratory function, sustain blood circulation, and protect the rescuer from potential infection. This method uses a transparent mask with a one-way valve, making it a versatile and effective tool applicable to victims of all ages. Proper training is crucial for the effective delivery of Mouth-to-Mask Ventilation in life-saving situations.


Advantages of Mouth to Mask Ventilation

Mouth-to-Mask Ventilation offers several advantages over traditional mouth-to-mouth resuscitation, making it a valuable alternative in emergency situations:

  1. Reduced Risk of Infection Transmission: The transparent mask, equipped with a one-way valve, prevents direct contact with the victim's respiratory secretions and reduces the risk of infection transmission. This is especially important in situations where the victim's infection status is unknown or when there are concerns about contagious diseases.
  2. Increased Safety for Rescuers: Mouth-to-Mask Ventilation provides rescuers with greater protection from potential risks associated with mouth-to-mouth resuscitation. By using the mask with a one-way valve, the rescuer avoids inhaling exhaled air or contaminants from the victim, promoting a safer resuscitation process.
  3. Enhanced Efficiency: The one-way valve in the mask allows for the efficient delivery of rescue breaths without interference from the rescuer's exhaled air. This ensures that the victim receives a higher concentration of oxygen during ventilation, making Mouth-to-Mask Ventilation more effective in supporting oxygenation and improving the chances of successful resuscitation.
  4. Universal Applicability: Mouth-to-Mask Ventilation is suitable for victims of all age groups, including infants, children, and adults. Rescuers can easily adjust the mask size to fit the victim's face, making it a versatile technique in various emergency scenarios.
  5. Complements Advanced Airway Management: In advanced life support situations, Mouth-to-Mask Ventilation complements the use of advanced airway devices, such as bag-valve-mask (BVM) or supraglottic airways. Rescuers can maintain oxygenation while securing a more stable airway for the victim, optimizing the overall resuscitation efforts.
  6. Enhanced Visibility: The transparent nature of the mask allows the rescuer to observe the victim's mouth and nose for any obstructions, regurgitation, or signs of breathing. This visibility aids in the prompt identification of potential issues that may require additional intervention.
  7. Simplicity and Readiness: Mouth-to-Mask Ventilation is relatively simple to perform and requires minimal equipment. Trained rescuers can quickly apply the technique during emergencies, ensuring a rapid response when time is critical.


Mouth to Mask Ventilation for 2 Rescuer CPR

Mouth-to-Mask Ventilation for 2 Rescuer CPR allows for effective and continuous cardiopulmonary support, maximizing the chances of successful resuscitation. It is important for both rescuers to communicate and work together seamlessly to ensure a coordinated and efficient response in critical emergencies. The steps involved in Mouth-to-Mask Ventilation for 2 Rescuer CPR are as follows:

  1. Assess the Situation and Call for Emergency Assistance: As soon as you encounter an unresponsive victim not breathing normally, call for emergency medical help or ask someone nearby to do so. Make sure the area around the victim is safe for performing CPR.
  2. Position the Victim on a Firm Surface: Lay the victim on their back on a firm and flat surface. Ensure that the victim's head is aligned with their body, and their airway is open.
  3. Open the Victim's Airway: Kneel beside the victim's head and perform the head-tilt/chin-lift maneuver to open their airway. This involves gently tilting the victim's head back while lifting their chin forward.
  4. One Rescuer Begins Chest Compressions: The rescuer positioned at the victim's side starts chest compressions. Place the heel of one hand on the center of the victim's chest (between the nipples) and the other hand on top of the first hand. Compress the chest at least 2 inches (5 centimeters) deep at a rate of 100-120 compressions per minute.
  5. Second Rescuer Delivers Rescue Breaths: The second rescuer positions themselves at the victim's head, holding the transparent face mask with the appropriate size for a secure seal. The rescuer opens the victim's mouth and positions the mask over the nose and mouth to ensure an airtight seal.
  6. Deliver Rescue Breaths: The second rescuer takes a normal breath and delivers two rescue breaths into the mask over a duration of 2 seconds each. Each breath should be forceful enough to make the victim's chest rise visibly.
  7. Coordination between Compressions and Ventilations: Both rescuers coordinate their efforts to ensure the appropriate compression-ventilation ratio. The recommended ratio for two-rescuer CPR is 30 compressions followed by 2 ventilations.
  8. Continue CPR Cycles: After each set of rescue breaths, the rescuer delivering compressions immediately resumes chest compressions while the second rescuer positions the mask and delivers the next set of rescue breaths. This cycle is repeated continuously until professional medical help arrives or the victim starts breathing spontaneously.


Mouth to Mask Ventilation Rates

The recommended ventilation rate for Mouth-to-Mask Ventilation during cardiopulmonary resuscitation (CPR) varies based on the age group of the victim. The American Heart Association (AHA) provides specific guidelines for ventilation rates for different age groups:


  • For Adults: The recommended ventilation rate for adults, including adolescents and older children, during CPR is 10 to 12 breaths per minute. This means delivering one rescue breath approximately every 5 to 6 seconds.
  • For Infants and Children: The recommended ventilation rate for infants and children during CPR is 12 to 20 breaths per minute. This means delivering one rescue breath approximately every 3 to 5 seconds for infants and 3 to 6 seconds for children.


It is important to deliver rescue breaths at the appropriate rate to ensure effective oxygenation and ventilation during CPR. Maintaining the correct ventilation rate is crucial for supporting the victim's circulation and oxygenating their lungs to improve their chances of survival.


What are the Different Mask Devices available for Rescue Breathing?

There are several different mask devices available for rescue breathing and ventilation during CPR and emergency first aid. These mask devices are designed to provide a barrier-protected method of delivering rescue breaths to a victim while minimizing the risk of infection transmission. Some common mask devices include:

  • Pocket Mask: A pocket mask is a compact and portable mask that is commonly used in CPR training and actual emergency situations. It consists of a transparent mask with a one-way valve and an oxygen inlet. The one-way valve allows the rescuer to deliver rescue breaths to the victim while preventing backflow of air or contaminants from the victim to the rescuer.
  • Bag-Valve-Mask (BVM): A bag-valve-mask, also known as a resuscitator or Ambu bag, is a handheld device used by medical professionals to provide positive-pressure ventilation to patients in respiratory distress or cardiac arrest. It consists of a self-inflating bag, a face mask, and an oxygen reservoir. The rescuer squeezes the bag to deliver breaths to the victim, and the one-way valve ensures that the air flows in only one direction.
  • Pocket Face Shield: A pocket face shield is a small, disposable shield that provides a barrier between the rescuer's mouth and the victim's mouth during rescue breathing. It is designed to prevent direct contact with the victim's respiratory secretions and minimize the risk of infection transmission.
  • CPR Masks with Filter: Some CPR masks come with built-in filters that provide additional protection for both the rescuer and the victim. These filters help prevent the transmission of bacteria and viruses, making them particularly useful in situations where the infection status of the victim is unknown.

Guidelines and Considerations

Ensuring personal safety and using personal protective equipment (PPE) is important when providing rescue breaths during CPR or emergency first aid. By wearing appropriate PPE, such as gloves and a mask with a one-way valve, rescuers protect themselves from infection transmission, communicable diseases, and potential aerosol generation.

Prioritizing personal safety allows rescuers to focus on the victim, provide continuous assistance, and have a positive impact on public health. Proper training and certification in CPR and first aid further enhance the rescuer's knowledge and effectiveness in emergency situations. Taking care of personal safety enables rescuers to be confident and efficient, ensuring optimal care for the victim in critical situations.

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Blood Pressure Chart by Age

Age Group
Min Systolic/Diastolic
Normal Range
Max Systolic/Diastolic
1-12 months
Consult pediatrician if outside normal range. Cuff sizing is critical.
1-5 years
High BP in children may indicate underlying condition. Lifestyle factors.
6-13 years
Obesity, family history increase risk. Promote healthy habits early.
14-19 years
Adolescent rise normal. Rule out secondary causes if elevated.
20-24 years
Stressors, medications may impact. Start monitoring if high-normal.
25-29 years
Dietary changes, exercise for elevated readings. Birth control effects.
30-39 years
110/77 - 111/78
122/81 - 123/82
134/85 - 135/86
Monitor closely if readings increasing with age.
40-49 years
112/79 - 115/80
125/83 - 127/84
137/87 - 139/88
Lifestyle changes proven to reduce hypertension risk.
50-64 years
116/81 - 121/83
129/85 - 134/87
142/89 - 147/91
White coat effect common. Home monitoring advised.
65+ years
130+ Systolic Risk
Frailty, medications, conditions factored in management.

Aftercare and Monitoring

After administering rescue breaths and initiating CPR, the following steps are essential for post-resuscitation care:

  1. Chest Compressions: If the victim is still unresponsive or not breathing adequately after rescue breaths, chest compressions should be continued according to the recommended compression-ventilation ratio.
  2. Early Defibrillation: If an automated external defibrillator (AED) is available, follow the AED prompts to assess and deliver a shock if necessary. Early defibrillation is crucial in cases of sudden cardiac arrest caused by certain types of cardiac arrhythmias.
  3. Recovery Position: If the victim regains consciousness and starts breathing normally, place them in the recovery position to maintain an open airway and reduce the risk of aspiration.
  4. Continuous Monitoring: Keep monitoring the victim's vital signs, responsiveness, and breathing status. Record any changes in their condition for accurate reporting to emergency medical services (EMS) personnel.


CPR Training and Certification

The importance of formal training and certification in Mouth-to-Mask Ventilation cannot be overstated, especially for healthcare professionals and individuals working in high-risk environments. Proper training ensures that rescuers have the necessary knowledge, skills, and confidence to effectively deliver rescue breaths and provide life-saving assistance during emergencies.


Healthcare professionals and individuals interested in obtaining proper certification in Mouth-to-Mask Ventilation and other life-saving techniques can seek local first aid courses. These courses are often offered by various organizations, including:

  • American Heart Association (AHA): The AHA provides certified first aid courses that cover Mouth-to-Mask Ventilation and other critical CPR techniques.
  • American Red Cross: The American Red Cross also offers comprehensive first aid courses that include training in rescue breathing and other vital emergency response skills.
  • Local Hospitals and Healthcare Institutions: Many hospitals and healthcare facilities offer first aid and CPR training to their staff and the community. Contact your local healthcare institutions to inquire about available courses.


For lay rescuers who may not have regular exposure to medical settings, obtaining proper training is equally important. There are several ways lay rescuers can practice and improve their skills including Community First Aid Courses and Online Training.