From the Guidelines
Chest compressions should not be delayed during intubation in cardiac arrest, and continuous high-quality CPR should be maintained with only a brief pause when passing the endotracheal tube through the vocal cords. This approach prioritizes maintaining coronary and cerebral perfusion, which is crucial for survival outcomes. The most recent and highest quality study, published in 2019 1, supports the use of advanced airways during cardiac arrest, but emphasizes the importance of minimizing interruptions to chest compressions.
Key Considerations
- The intubation team should coordinate with the compression team to minimize interruptions, with clear communication when a brief pause is needed 1.
- Alternative airway management strategies like supraglottic airways can be considered initially, as they require minimal interruption to compressions 1.
- If multiple intubation attempts are needed, return to bag-mask ventilation between attempts while maintaining compressions 1.
- Continuous waveform capnography should be used after tube placement to confirm proper positioning while CPR continues 1.
Evidence-Based Recommendations
The 2019 American Heart Association focused update on advanced cardiovascular life support 1 provides the most recent guidance on the use of advanced airways during cardiac arrest. This update emphasizes the importance of minimizing interruptions to chest compressions and highlights the need for coordinated teamwork to achieve this goal. By following these recommendations, healthcare providers can optimize cardiac arrest management and improve patient outcomes.
From the Research
CPR Delay During Intubation
- CPR delay during intubation is a critical issue in cardiopulmonary resuscitation, as interruptions in chest compressions can be detrimental to patient outcomes 2.
- A study published in 2023 found that first attempt success with tracheal intubation was higher when CPR was continued rather than paused, with a success rate of 87% compared to 65% 3.
- The use of laryngeal mask airway (LMA) has been proposed as an alternative to endotracheal intubation, with studies showing that it can provide a rapid and easily achieved patent airway that permits positive pressure ventilation 4, 5.
- However, the LMA may not protect against aspiration, and its use should be carefully considered in patients with difficult airways 4, 6.
- Video laryngoscopy (VL) has been shown to be an easier method with a shorter intubation time than LMA using a bougie, and causes a lower incidence of coughing and laryngospasm in patients who need intubation 6.
- The intubating laryngeal mask airway (ILMA) has been used successfully in the emergency department, with a high success rate for oxygenation and ventilation, and reasonable intubation success even when used infrequently by emergency physicians 5.