Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation

Christopher Newell, Scott Grier, Jasmeet Soar, Christopher Newell, Scott Grier, Jasmeet Soar

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.

Keywords: Airway; Cardiac arrest; Cardiopulmonary resuscitation; Oxygenation; Ventilation.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

CN and SG declare no conflicts of interest. JS is a paid Editor for the journal Resuscitation, Chair of the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation (ILCOR) and a steering group member for the AIRWAYS-2 Study.

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Figures

Fig. 1
Fig. 1
Stepwise approach to airway management during cardiopulmonary resuscitation

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