Airway and Ventilation during CPR
The primary components of standard cardiopulmonary resuscitation (CPR) are chest compressions to circulate blood, defibrillation to convert a ‘shockable’ rhythm into one that will produce a spontaneous circulation, and ventilation of the lungs to enable oxygenation of the blood and removal of carbon dioxide (CO2). Effective ventilation of the lungs requires a patent airway, while protection of the lungs from aspiration of gastric contents requires reliable separation of the gastrointestinal tract from the airway. Traditionally, the single airway device deemed capable of maintaining airway patency and protecting from aspiration is the tracheal tube. However, the unique status of tracheal intubation is now being challenged. Tracheal intubation is associated with several complications and it is possible that it would be better for healthcare professionals who are not highly skilled in this intervention to use alternative airway devices. After primary cardiac arrest, based mainly on animal data, but also on some low-level human data, ventilation may not be necessary for several minutes. Recent observational clinical studies suggest that chest compression-only CPR by bystanders results in the same or better outcomes than bystander CPR that includes both mouth-to-mouth breathing and chest compressions. There are data indicating that excessive ventilation is harmful during CPR and, possibly, after return of spontaneous circulation. This chapter will focus on the evidence supporting new strategies for management of the airway and ventilation during CPR.
KeywordsCardiac Arrest Tracheal Intubation Emergency Medical Service Laryngeal Mask Airway Chest Compression
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