An endotracheal tube (ETT) is a medical device that a healthcare provider places into a person’s windpipe, or trachea. This tube acts as a secure pathway for air, ensuring oxygen reaches the lungs directly. In cardiopulmonary resuscitation (CPR), chest compressions manually pump blood throughout the body, particularly to vital organs like the brain and heart. Ventilations, or rescue breaths, supply oxygen to the lungs and help remove carbon dioxide, which prevents oxygen deficiency and maintains the body’s balance during cardiac arrest.
Facilitating Continuous Chest Compressions
During basic CPR without an advanced airway, chest compressions are paused to deliver rescue breaths, often in a 30:2 ratio. With an endotracheal tube in place, ventilations can be delivered without interrupting chest compressions. This is known as asynchronous ventilation, where compressions continue at a rate of 100-120 per minute while breaths are given separately, typically one breath every 6 seconds for adults.
Maintaining continuous chest compressions is important for circulating blood. Each compression helps build pressure to perfuse the heart and brain, and pausing compressions rapidly decreases this pressure, requiring time to rebuild it. The presence of an ETT allows for a higher chest compression fraction, meaning more time is spent actively compressing the chest, which leads to better blood flow to vital organs. This continuous flow of blood is associated with improved chances of successful resuscitation.
Optimizing Ventilation Delivery
The endotracheal tube enhances the effectiveness and control of ventilations during CPR by securing the airway. Once placed, the ETT forms a sealed pathway directly into the trachea, ensuring delivered breaths go into the lungs and prevent air from entering the stomach. This prevents gastric inflation, which can lead to complications like regurgitation and aspiration.
With an ETT, healthcare providers gain more precise control over the volume and pressure of delivered breaths compared to less secure methods like bag-mask ventilation. This sealed system allows for more effective oxygen delivery and carbon dioxide removal, which are important for maintaining cellular function and preventing acidosis. Ventilations can be delivered asynchronously.
Integrated Effect on Resuscitation Efforts
The combined ability to perform continuous chest compressions and simultaneous, controlled ventilations through an endotracheal tube optimizes the CPR process. This integrated approach ensures blood circulation and oxygen delivery occur with minimal interruption, which improves patient outcomes during cardiac arrest. By separating the two actions, the ETT allows each CPR component to be performed more efficiently.
Monitoring the effectiveness of these efforts is also enhanced with an ETT. Continuous waveform capnography, which measures carbon dioxide in exhaled air, can confirm proper ETT placement and assess the quality of chest compressions and ventilations. Higher end-tidal carbon dioxide (ETCO2) levels indicate better blood flow and more effective compressions, providing real-time feedback to guide resuscitation efforts. A sudden, sustained increase in ETCO2 can even signal the return of spontaneous circulation, indicating the heart has resumed pumping effectively.
The use of an ETT transforms CPR into a more continuous effort. This continuity in both blood flow and oxygen supply supports the body’s metabolic needs during cardiac arrest, aiming to preserve organ function until the heart can be restarted. While ETT placement requires skilled personnel and can cause brief interruptions if not performed efficiently, its benefits in maintaining high-quality CPR make it important in advanced resuscitation.