Chapter 7: 2-Rescuer CPR and Bag-Mask Ventilation

When two trained rescuers are available, CPR should be performed as a coordinated team. One rescuer should take a leadership role to coordinate tasks, monitor quality, and direct compressor switches. Team-based CPR improves compression quality, reduces fatigue, and supports effective ventilation.

Adult 2-Rescuer CPR

Rescuer 1 – Compressions

• Begin chest compressions immediately.
• Compress at least 2 inches (5 cm), but no more than 2.4 inches (6 cm).
• Maintain a rate of 100–120 compressions per minute.
• Allow full chest recoil after each compression.
• Minimize interruptions (no more than 10 seconds).
• Switch compressors about every 2 minutes (or sooner if fatigued).

Compression-to-Ventilation Ratio (Adults)

• 30 compressions to 2 breaths (30:2)

Rescuer 2 – Airway and Ventilation

• Open the airway using the head-tilt, chin-lift (unless spinal injury suspected).
• Deliver breaths using a bag-mask device.
• Provide 2 breaths after each compression cycle.
• Each breath should last about 1 second and produce visible chest rise.
• Avoid excessive ventilation.
• Monitor compression quality and prepare the AED.
• Coordinate compressor switches efficiently to limit pauses.

Using a Bag-Mask Device (BVM)

A bag-mask device is commonly used in healthcare settings to deliver assisted ventilation.

• Select the correct mask size to create a proper seal over the nose and mouth.
• Use the E-C clamp technique to hold the mask:
  • “C” forms a seal with a thumb and index finger.
  • “E” lifts the jaw to maintain airway position.

• Attach the bag to oxygen when available (up to 15 L/min).
• Squeeze the bag just enough to produce visible chest rise.
• Deliver each breath over 1 second.
• Provide only enough volume to produce visible chest rise.
• If the chest does not rise:
  • Reposition the head.
  • Re-establish the mask seal.
  • Check for visible airway obstruction.

High-quality CPR in a team setting works best when everyone communicates clearly, keeps interruptions short, uses proper ventilation technique, switches roles often to prevent fatigue, and encourages one another to stay strong and focused.