Management of Vomiting During Cardiac Arrest When Suction is Available
When suction is available during cardiac arrest with vomiting, immediately turn the patient to the side, use the suction device to clear the airway, and resume chest compressions within 10 seconds. 1
Immediate Airway Clearance Protocol
Use suction equipment fitted with large-bore, nonkinking tubing and semirigid pharyngeal tips to rapidly evacuate vomitus from the oropharynx. 2 The American Heart Association specifies that suction devices should provide airflow >40 L/min at the end of the delivery tube and vacuum >300 mm Hg when the tube is clamped. 2
Step-by-Step Approach:
Pause compressions briefly (target <10 seconds total interruption) when vomiting is observed. 1
Turn the patient onto their side using a log-roll technique if cervical spine injury is suspected. 1
Apply suction immediately to the oropharynx using the large-bore pharyngeal tip, as this equipment significantly outperforms standard small-diameter suction—reducing evacuation time by up to 10-fold for viscous and particulate material. 3, 4
Resume chest compressions as soon as the airway is cleared, keeping the total pause under 10 seconds. 1
Critical Equipment Specifications
Both portable and installed suction units should be immediately available for resuscitation emergencies. 2 The equipment must include:
- Large-bore (3/4-inch), nonkinking suction tubing connected to semirigid pharyngeal tips 2
- Adequate vacuum power (>300 mm Hg) and flow (>40 L/min) 2
- Multiple sterile suction catheters of various sizes for advanced airway suctioning if an endotracheal tube or supraglottic airway is placed 2
Compression Interruption Limits and Outcomes
Every interruption in chest compressions directly impacts survival—preshock pauses longer than 10 seconds reduce survival to hospital discharge, with each additional 5-second pause increasing odds of death (OR 1.86,95% CI 1.10-3.15). 1
- Target chest compression fraction should be ≥60% throughout the resuscitation. 1
- All pauses, including those for airway clearance, must be limited to <10 seconds whenever feasible. 1
Team Coordination Strategy
- Assign one rescuer to manage suction and airway clearance while another remains positioned to restart compressions immediately. 1
- Rotate the compressor at least every 2 minutes to prevent fatigue-related decline in compression quality. 1
- Have the suction device ready and accessible at the bedside before starting resuscitation to avoid delays. 5
Common Pitfalls to Avoid
Do NOT use abdominal thrusts or the Heimlich maneuver to clear vomitus during CPR—these maneuvers are unnecessary and potentially dangerous. 6, 1
- Do NOT perform prolonged airway-clearance techniques that extend interruption beyond 10 seconds. 1
- Do NOT check for pulse or cardiac rhythm while managing vomiting—focus solely on airway clearance and rapid resumption of compressions. 1
- Do NOT use standard small-diameter (1/4-inch) suction tubing for particulate vomitus, as it frequently obstructs and requires 10-fold longer evacuation time compared to large-bore equipment. 3, 4
Clinical Context and Incidence
Vomiting is extremely common during cardiac arrest resuscitation—approximately two-thirds of victims receiving rescue breathing vomit, and 86% of those requiring combined compressions and ventilations experience vomiting. 6, 1, 7 This high incidence makes immediate access to functional suction equipment essential for all resuscitation attempts.