Which of the following best addresses poor BVM ventilation when initial attempts fail?

• A. Re-seal the mask, re-position the head, suction the airway, and reattempt ventilation
• B. Increase oxygen flow to maximum without changing mask technique
• C. Stop ventilation and call for advanced airway
• D. Remove the mask and discontinue ventilation

Answer: (C)

When bag-valve-mask ventilation isn’t delivering adequate ventilation after optimizing technique, the priority is to secure a definitive airway. The best step is to pause the bagging and call for advanced airway support so you can prepare for endotracheal intubation or place a supraglottic airway. This escalation addresses the underlying issue of an insufficient airway when simple maneuvers and oxygen flow no longer resolve the problem, reducing ongoing hypoxia risk.

Increasing the oxygen flow without fixing the airway mechanics won’t compensate for a poor seal or a blocked/unsafe airway. Removing the mask and stopping ventilation abandons the patient to continue without oxygen. While re-sealing, repositioning, suctioning, and reattempting ventilation are appropriate initial corrective actions, once those attempts have failed, moving toward an advanced airway is the correct next move.