Excellence in Facemask Ventilation; Roadside to Resus

Face mask ventilation serves as a fundamental resuscitation skill rather than a simple, preliminary step in airway management. Achieving excellence requires meticulous attention to patient positioning, such as aligning the ear canal with the sternal notch, and employing two-handed techniques to ensure an adequate mask seal. Clinicians must prioritize tactile feedback and objective monitoring, including end-tidal CO2, to prevent complications like gastric inflation caused by excessive pressure. Evidence, including the CAM trial, demonstrates that effective oxygen delivery remains the primary goal, with outcomes often comparable between bag-valve-mask ventilation and endotracheal intubation in cardiac arrest scenarios. When face mask ventilation fails or becomes unsustainable, clinicians should transition to alternative strategies like supraglottic airways or intubation, guided by the Vortex approach, which prioritizes continuous oxygenation over the rigid hierarchy of airway devices.