Cardiopulmonary Resuscitation (CPR) is a life-saving technique performed during cardiac arrest to maintain blood flow to the brain and other organs. While the goal of circulating oxygenated blood remains constant, CPR techniques can change based on the patient’s condition and available equipment. A significant modification occurs when an advanced airway is in place, altering how chest compressions and ventilations are coordinated.
Understanding Advanced Airways
An “advanced airway” refers to specialized devices used to secure a patient’s breathing passage. These devices create a direct, open path to the lungs, used when a patient cannot maintain their own airway or requires mechanical breathing support. Advanced airways are employed in situations like cardiopulmonary resuscitation, anesthesia, and intensive care.
Common types include endotracheal tubes (ET tubes) and supraglottic airways, such as laryngeal mask airways (LMAs). An ET tube is a flexible plastic tube placed through the mouth or nose, past the vocal cords, and directly into the trachea. This provides a sealed conduit for air, protecting the airway from aspiration. Supraglottic airways, like LMAs, are less invasive and sit above the vocal cords to provide an unobstructed pathway for ventilation without entering the trachea. They are inserted by trained medical professionals.
Standard Cardiopulmonary Resuscitation Basics
Standard CPR, performed without an advanced airway, focuses on a rhythmic balance between chest compressions and rescue breaths. For adults, the recommended ratio is 30 chest compressions followed by 2 rescue breaths.
Chest compressions should be delivered at a rate of 100 to 120 compressions per minute, pushing down at least 2 inches but not more than 2.4 inches on the center of the chest. Full chest recoil should be allowed between compressions to ensure the heart refills. Interruptions to compressions should be minimized to less than 10 seconds to maintain consistent blood flow. The 30:2 ratio balances blood circulation from compressions with oxygen delivery from ventilations, especially when the airway is unprotected.
Cardiopulmonary Resuscitation When an Advanced Airway is in Place
When an advanced airway is secured, the approach to CPR changes significantly. The primary difference is the shift from cycles of compressions and breaths to continuous chest compressions with asynchronous ventilations.
The rescuer performing chest compressions should continue at a steady rate of 100 to 120 compressions per minute without interruption. Simultaneously, a separate rescuer manages the advanced airway and delivers ventilations. Breaths are given asynchronously, not synchronized with chest compressions.
One breath is delivered every 6 seconds (about 10 breaths per minute). Each breath should last about 1 second and cause visible chest rise, ensuring air reaches the lungs. This method allows for uninterrupted blood flow to the heart and brain.
Key Principles and Team Coordination
Effective CPR with an advanced airway relies on clear communication and coordinated teamwork among rescuers. Once an advanced airway is in place, team members can specialize their roles. One rescuer can focus solely on delivering continuous, high-quality chest compressions at the recommended rate and depth. Another rescuer can concentrate on providing ventilations through the advanced airway, ensuring proper breath delivery and monitoring.
Continuous monitoring of the patient’s condition is important, using tools such as end-tidal carbon dioxide (EtCO2) monitoring, also known as capnography. This technique measures CO2 in exhaled breath, providing real-time feedback on the effectiveness of chest compressions and the adequacy of ventilation. An EtCO2 reading of at least 10 mmHg, ideally above 20 mmHg, indicates effective CPR and sufficient blood flow to the lungs. Monitoring EtCO2 also helps confirm correct advanced airway placement and can signal the return of spontaneous circulation.
Avoiding hyperventilation is important as it can increase pressure within the chest, potentially reducing blood flow back to the heart and decreasing overall cardiac output. Rescuers should rotate roles every 2 minutes to prevent fatigue and maintain compression quality.