Cardiopulmonary Resuscitation (CPR) is a life-saving technique performed when someone’s breathing or heart stops, such as during cardiac arrest. It involves a combination of chest compressions and rescue breaths to circulate oxygenated blood to the brain and other organs. When a specialized device called an “advanced airway” is put in place, the usual CPR approach changes. This article explains the specific adjustments made to CPR when an advanced airway is used.
What is an Advanced Airway in CPR?
An advanced airway is a medical device inserted into a patient’s windpipe (trachea) or throat (pharynx) to create a secure, open path for air to reach the lungs. This device allows for the effective delivery of ventilations during resuscitation efforts. Common examples of advanced airways used in emergency settings include an endotracheal tube (ET tube), which goes directly into the trachea, and supraglottic airways (SGAs), such as the laryngeal mask airway (LMA) or King tube, which sit above the voice box.
The goal of placing an advanced airway during CPR is to ensure a reliable and consistent supply of oxygen to the patient’s lungs. It also helps prevent aspiration, which is the inhalation of stomach contents into the lungs, a serious complication during resuscitation. Furthermore, an advanced airway facilitates more efficient and controlled ventilation.
How CPR Changes with an Advanced Airway
When an advanced airway is in place, the traditional cycle of chest compressions interrupted by breaths changes significantly. The two main procedural differences are continuous chest compressions and asynchronous ventilations. This modified approach is performed by highly trained medical professionals, such as paramedics, doctors, and nurses.
With an advanced airway, chest compressions continue uninterrupted at a consistent rate, 100 to 120 compressions per minute. This continuous compression aims to maximize blood flow to the heart and brain, which are highly sensitive to interruptions in circulation.
Asynchronous ventilations are delivered independently of ongoing chest compressions. For adults, the ventilation rate is one breath every 6 seconds, or about 10 breaths per minute. This allows for steady oxygen delivery without disrupting the flow of blood generated by the compressions.
The Physiological Basis for Modified CPR
The procedural changes in CPR with an advanced airway are rooted in physiological advantages that improve patient outcomes. Continuous chest compressions maintain consistent blood flow to the heart and brain, which are vulnerable to oxygen deprivation during cardiac arrest. Interruptions, even brief ones, cause a significant drop in blood pressure and reduce vital organ perfusion, taking several compressions to restore adequate pressure, thus maximizing coronary and cerebral perfusion.
An advanced airway ensures delivered ventilations are effective and directed into the lungs, preventing air from entering the stomach, a complication known as gastric inflation. Gastric inflation can lead to regurgitation and aspiration of stomach contents, which can be fatal.
The secure seal provided by an advanced airway allows for optimal oxygenation without compromising the quality or continuity of chest compressions. This dual benefit of continuous blood flow and effective, controlled ventilation enhances the overall effectiveness of CPR.