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Next-gen BVM

Protect patients from over-ventilation and pulmonary injury with a bag-valve-mask that helps regulate rate and volume

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The BVM has remained relatively unchanged, but its simplicity doesn’t mean proper technique isn’t important, nor that it can be improved upon.


Sponsored by Pulmodyne

By EMS1 BrandFocus staff

Bag-valve-mask (BVM) ventilation is a critical EMS skill, requiring training in proper technique. This includes patient positioning, achieving a good face seal and providing ventilations at the recommended rate and volume. Advances in BVM technology can help rescuers achieve optimal patient ventilation.

According to studies, over-ventilation with BVMs occurs frequently during use in both pre-hospital and hospital settings. Excessive respiratory rates and/or tidal volumes during BVM use result in the increased likelihood of adverse outcomes. The longer the period of over-ventilation, the more likely the patient is to experience related complications. This includes reduced cardiac output, hypotension, lung damage (i.e. pneumothorax or ARDS), gastric inflation with subsequent emesis and aspiration, cerebral hypoxia/neurological damage and decreased chance of survival.


Drs. Holger Hesse and Henning Reuben developed the original BVM concept in 1953. Their artificial manual breathing unit (AMBU) resuscitator was manufactured and brought to market in 1956. The BVM has remained relatively unchanged since and is largely considered a Gen 1 device. Its simplicity doesn’t mean proper technique isn’t important, nor that it can’t be improved upon.

Within the scope of airway management devices and equipment, there are a number of options available to promote affordability, efficient storage and deployment, and consistent application. One of the main problems with the current BVMs available on the market is their inability to control the rate of insufflation and the amount of tidal volume delivered to the patient.

The stressful nature of cardiac arrest calls can lead to over-ventilation. Techniques to avoid over-ventilation include:

  • Know the ventilation rate. The AHA recommends delivering 10 breaths per minute of 500-600 mL to a standard adult – or about one breath every 6 seconds.
  • Monitor with capnography. The waveform indicates respiratory rate, provides an indirect measurement of CPR quality and can help assist in establishing the prognosis of the patient.
  • Know how much air to give. Most standard adult BVMs hold 1.5 L of air or more – almost three times the American Heart Association’s estimated average adult tidal volume of 500-600 mL. However, this varies from one patient to the next. Rescuers need enough air to see adequate chest rise and fall with each ventilation.
  • Use next-gen technology to help control tidal volume and rate. Minimize variability and prevent over-ventilation with BVM timed refill and volume-specific compression point features.


The VT Select BVM, from Pulmodyne, is a manual resuscitator with a tactile feedback system designed to help control rate and volume. The bag features a delayed refill valve setting which acts as a timer between breaths by restricting the refill of the bag to ~4.5 seconds. Full re-inflation of the bag cues the user to deliver another breath resulting in a respiratory rate of ~10 breaths per minute. The finger ridges act as compression point indicators. When compressed until fingers and thumb touch ~500-600 mL of volume is delivered to the patient. This meets the American Heart Association’s recommended delivery of 10 breaths per minute to adults and delivers their estimated average adult volume of 500-600 mL.

The VT Select BVM is smaller (1200 mL) than most adult bags on the market, which helps to reduce the risk of hyperinflation or barotrauma. The VT Select can be supplied with an optional PEEP valve, filter and dial manometer.

Manual ventilation can be a lifesaver, but only if administered properly. The technique is often highly variable from one provider to the next. The VT Select helps minimize variability and achieve recommended guidelines with its unique tactile feedback system that cues both volume and rate delivery.

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