how is cpr performed differently with advanced airway

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19-02-2025

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Cardiopulmonary resuscitation (CPR) is a life-saving technique used when someone's breathing or heartbeat has stopped. Standard CPR involves chest compressions and rescue breaths. However, when an advanced airway device is in place, the procedure changes slightly. This article will explain the differences.

Understanding Advanced Airways

Before diving into the specifics of CPR with an advanced airway, let's define what we mean. An advanced airway is a device inserted into the trachea (windpipe) to help deliver oxygen and ventilate the lungs more effectively than mouth-to-mouth resuscitation. Examples include:

• Endotracheal tubes (ETTs): These are tubes inserted through the mouth or nose and into the trachea.
• Laryngeal mask airways (LMAs): These are mask-like devices that seal over the opening of the larynx.
• Supraglottic airways: These are similar to LMAs, but sit above the glottis.

CPR Modifications with Advanced Airways

The core principle of CPR – chest compressions – remains the same regardless of whether an advanced airway is in place. However, the method of ventilation (providing breaths) changes significantly.

Ventilation Changes:

• No Rescue Breaths: With an advanced airway in place, you do not provide rescue breaths in the same way as with standard CPR. Instead, you use a bag-valve mask (BVM) or other ventilation device connected to the airway.

• Controlled Ventilations: Ventilations are delivered using a BVM device attached to the advanced airway. This allows for more controlled and consistent delivery of oxygen. The rate and volume of ventilations are typically guided by local protocols or advanced life support (ALS) providers.

• Monitoring for Chest Rise: While ventilating, visually check for adequate chest rise to ensure proper ventilation. Poor chest rise may indicate a problem with airway placement or ventilation technique.

Compression-to-Ventilation Ratio:

The standard compression-to-ventilation ratio changes with an advanced airway. The exact ratio may vary depending on specific guidelines and the situation, but generally focuses on continuous chest compressions. The rationale is that continuous chest compressions are more effective for maintaining blood flow to the brain.

• Typical Ratio: A common ratio is 30:2 (30 chest compressions to 2 ventilations). However, some newer guidelines prioritize continuous chest compressions with ventilations only as needed to maintain adequate oxygen saturation as measured by pulse oximetry.

• Emphasis on Chest Compressions: The focus shifts toward maintaining high-quality chest compressions, ensuring adequate depth and rate. This is crucial for maintaining blood circulation.

Other Considerations:

• Confirmation of Placement: Before initiating ventilations, proper placement of the advanced airway must be confirmed. This usually involves checking for chest rise, listening for breath sounds, and potentially using a capnograph (which measures carbon dioxide levels).

• Team Dynamics: CPR with an advanced airway is typically a team effort, requiring coordination between those performing compressions and those managing the airway and ventilation.

• Monitoring: Continuous monitoring of heart rhythm and oxygen saturation is crucial during CPR with an advanced airway.

Step-by-Step Guide to CPR with an Advanced Airway

While specific protocols can vary, here's a general overview:

1. Confirm Placement: Ensure the advanced airway is correctly placed and secured.
2. Attach BVM: Connect a bag-valve mask (BVM) to the advanced airway.
3. Chest Compressions: Perform high-quality chest compressions at the recommended rate and depth (at least 2 inches for adults).
4. Ventilations: Deliver ventilations using the BVM, ensuring adequate chest rise, aiming for a suitable compression-to-ventilation ratio based on current guidelines.
5. Monitor: Continuously monitor heart rhythm, oxygen saturation, and chest rise.

Conclusion

CPR with an advanced airway involves a shift in technique from standard CPR. The focus remains on effective chest compressions, but ventilation changes to utilize a BVM and focus on maintaining adequate oxygenation. Proper training and adherence to established guidelines are crucial for providing optimal care in these situations. Remember, always follow local protocols and consult with a healthcare professional for the latest updates on CPR guidelines.