Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation

Abstract

After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of spontaneous circulation (ROSC). The optimal combination of airway techniques, oxygenation and ventilation is uncertain. Current guidelines are based predominantly on evidence from observational studies and expert consensus; recent and ongoing randomised controlled trials should provide further information. This narrative review describes the current evidence, including the relative roles of basic and advanced (supraglottic airways and tracheal intubation) airways, oxygenation and ventilation targets during CPR and after ROSC in adults. Current evidence supports a stepwise approach to airway management based on patient factors, rescuer skills and the stage of resuscitation. During CPR, rescuers should provide the maximum feasible inspired oxygen and use waveform capnography once an advanced airway is in place. After ROSC, rescuers should titrate inspired oxygen and ventilation to achieve normal oxygen and carbon dioxide targets.

Comparing the neurologic outcomes of patients with out-of-hospital cardiac arrest according to prehospital advanced airway management method and transport time interval

“…2,3 After the return of spontaneous circulation (ROSC), performing endotracheal intubation (ETI) elicits controlled and effective ventilation that is necessary while transporting the patient with OHCA to the emergency department. 4 Advanced airway management including ETI or the use of supraglottic airway (SGA) devices can facilitate the performance of high-quality CPR without interrupting chest compressions (as would be required with BVM ventilation) and increases the rates of short-term survival, ROSC, and survival to admission. 5,6 ETI, which prevents airway obstruction and facilitates airway management, is preferred by hospitals, although performing it requires high skill.…”

Efficacy of Amflow®, a Real-Time-Portable Feedback Device for Delivering Appropriate Ventilation in Critically Ill Patients: A Randomised, Controlled, Cross-Over Simulation Study

“…Feedback for delivering appropriate V T is not easy due to inherent technical difficulties. V T can be easily varied according to individual factors, such as the manual technique used for squeezing the bag (i.e., one-handed or twohanded), hand size, grip speed, or power [1,2,4,21]. Numerous studies have reported that many rescuers do not deliver correct V T regularly in simulation settings [11-13, 21, 22].…”

“…Positive ventilations can be easily delivered by simply squeezing the bag. However, manual bagging may limit the delivery of appropriate and consistent tidal volume (V T ) because it can vary according to individual factors such as hand size, squeeze power, and technique [1][2][3][4]. e rescuers who deliver manual ventilation with a SB may often miss target numbers of ventilations per minute in real-world clinical settings if they are unable to continuously concentrate on the procedure.…”

Oxygen administration in patients recovering from cardiac arrest: a narrative review

“…Several groups proposed a ventilatory strategy for patients recovering from CA. Newell et al [58] recommended that the inspired oxygen should be titrated to achieve normal oxygen saturations (94-98%) once oxygenation can be reliably monitored. They also recommended that low tidal volume ventilation (6-8 ml/kg of ideal body weight) should be used with titrated levels of positive end-expiratory pressure to aim for normocapnia [58].…”