During cardiopulmonary resuscitation, if the patient vomits, should we keep compressions ongoing while turning the head to clear the airway, or pause compressions and perform a log roll to clear the vomitus?

Management of Vomiting During CPR

Continue chest compressions without interruption while turning the patient's head to the side and clearing visible vomitus with suction or manual removal—do not stop compressions to perform a log roll. 1

Rationale: Minimizing Compression Interruptions is Critical

The fundamental principle guiding this recommendation is that interruptions in chest compressions directly compromise survival outcomes 1, 2. The American Heart Association emphasizes that providers should minimize the number and duration of interruptions in chest compressions, with a goal to limit interruptions to no more than 10 seconds 1.

Why Continuous Compressions Matter

• Chest compression fraction (CCF) should exceed 80% to optimize outcomes, requiring careful management of all interruptions 1
• Interrupting compressions for mouth-to-mouth ventilation requires a period of "rebuilding" coronary perfusion pressure to reach pre-interruption levels 3
• Studies demonstrate that continuous chest compression CPR produces significantly better neurologically normal 24-hour survival compared to standard CPR with frequent interruptions (12 of 15 versus 2 of 15 survivors in animal models) 3
• Any technique that minimizes lengthy interruptions of chest compressions during the first 10-15 minutes of basic life support should be given serious consideration 3

Practical Approach to Vomiting During CPR

Immediate Actions (Without Stopping Compressions)

• Turn the patient's head to the side while compressions continue 4
• Use suction immediately if available to clear the airway 1, 4
• Manually remove visible vomitus from the mouth if suction is unavailable 1
• Position yourself to continue effective compressions while managing the airway 1

Tasks That Should NOT Require Compression Pauses

According to current guidelines, the following can be accomplished during ongoing chest compressions 1:

• Application of defibrillator pads
• Uncomplicated advanced airway placement
• IV/IO placement
• Airway suctioning and clearing

When a Brief Pause May Be Necessary

A pause in compressions should only be considered if 1:

• The patient cannot be ventilated effectively despite airway clearing attempts
• Complicated advanced airway placement is required
• The pause must be kept to less than 10 seconds 1

Team Coordination Strategy

Choreograph team activities in a "pit crew" fashion to avoid unnecessary pauses 1:

• One provider maintains continuous compressions
• A second provider manages the airway, turning the head and suctioning
• A third provider prepares ventilation equipment
• The team leader communicates clearly about any necessary brief pauses 1

If Advanced Airway is Already in Place

• Continue compressions without interruption 1
• The cuffed endotracheal tube provides protection against aspiration 1
• Suction through the endotracheal tube if needed 1
• Deliver asynchronous ventilations at 10 breaths per minute (1 breath every 6 seconds) without pausing compressions 1

Common Pitfalls to Avoid

• Do NOT perform blind finger sweeps, as these are not recommended and may worsen airway obstruction 1
• Do NOT stop compressions to log roll the patient unless absolutely necessary for safety or if the patient cannot be ventilated at all despite other measures 1
• Do NOT interrupt compressions to check for return of spontaneous circulation after clearing vomitus 1
• Avoid excessive concern about aspiration at the expense of perfusion—maintaining cardiac output through continuous compressions is the priority for survival 1, 3

Special Considerations

If the patient is in a lateral or recovery position when vomiting occurs, this actually facilitates drainage 4. However, optimal chest compressions require a firm, flat surface with the patient supine 1. The brief moment to reposition should be coordinated with other necessary tasks to minimize total interruption time 1.

The endotracheal tube with a cuff provides the best protection against aspiration if advanced airway management is indicated, but its placement should not cause prolonged compression interruptions 1.