What are the AHA guidelines for airway control and ventilation in ventricular tachycardia (VT)?

Updated: Dec 05, 2017
  • Author: Steven J Compton, MD, FACC, FACP, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

The AHA guidelines provide the following recommendations for airway control and ventilation [60, 81] :

  • Advanced airway placement in cardiac arrest should not delay initial CPR and defibrillation for VF arrest. (Class I)
  • If advanced airway placement will interrupt chest compressions, consider deferring insertion of the airway until the patient fails to respond to the initial CPR and defibrillation attempts or demonstrates ROSC. (Class IIb)
  • 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) The choice of bag-mask device versus advanced airway insertion should be determined by the skill and experience of the provider.
  • For healthcare providers trained in their use, either an supraglottic airway (SGA) device or an endotracheal tube (ETT) 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. (Class IIa)
  • 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 CO 2 detector, esophageal detector device, or ultrasonography used by an experienced operator is a reasonable alternative. (Class IIa)
  • After placement of an advanced airway, it is reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths/min) while continuous chest compressions are performed. (Class IIb)
  • 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)

There are no significant differences in the recommendations from the ERC or ILCOR. [61, 62]


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