What are the AHA recommendations for airway control and ventilation in cardiopulmonary resuscitation (CPR)?

Updated: Sep 15, 2020
  • Author: Catharine A Bon, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Answer

Answer

The AHA guidelines provide the following recommendations for airway control and ventilation [43] :

  • Advanced airway placement in cardiac arrest should not delay initial CPR and defibrillation for cardiac arrest

  • If advanced airway placement will interrupt chest compressions, consider deferring insertion of the airway until the patient fails to respond to initial CPR and defibrillation attempts or demonstrates return of spontaneous circulation

  • The routine use of cricoid pressure in cardiac arrest is not recommended (class III)

  • Either a bag-mask device or an advanced airway may be used for oxygenation and ventilation during CPR in both the in-hospital and out-of-hospital setting (class IIb); t

  • For healthcare providers trained in their use, either a supraglottic airway (SGA) device or an may be used as the initial advanced airway during CPR (class IIb)

  • Providers who perform endotracheal intubation should undergo frequent retraining (class I)

  • To facilitate delivery of ventilations with a bag-mask device, oropharyngeal airways can be used in unconscious (unresponsive) patients with no cough or gag reflex and should be inserted only by trained personnel (class IIa)

  • In the presence of known or suspected basal skull fracture or severe coagulopathy, an oral airway is preferred

  • Continuous waveform capnography in addition to clinical assessment is the most reliable method of confirming and monitoring correct placement of an ETT (class I)

  • If continuous waveform capnometry is not available, a nonwaveform carbon dioxide detector, esophageal detector device, and ultrasound used by an experienced operator are reasonable alternatives (class IIa)

  • Automatic transport ventilators (ATVs) can be useful for ventilation of adult patients in noncardiac arrest who have an advanced airway in place in both out-of-hospital and in-hospital settings (class IIb)

The recommendations from ERC or ILCOR do not differ significantly from those of the AHA. [47, 58]


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