Cardiopulmonary resuscitation, commonly known as CPR, is an emergency procedure performed when someone’s heart has stopped beating or they are no longer breathing effectively. This skill helps maintain blood flow and oxygen to the brain and other organs, buying time until professional medical help can arrive. When an advanced airway is in place, the technique for performing CPR changes significantly.
Understanding Standard CPR
Standard CPR, performed without specialized equipment, focuses on a rhythmic combination of chest compressions and rescue breaths. The sequence involves 30 chest compressions followed by two rescue breaths. This cycle repeats, pausing compressions briefly for ventilations. The goal is to circulate oxygenated blood and provide oxygen to the lungs through mouth-to-mouth or bag-mask ventilation. This interruption for breaths distinguishes conventional CPR.
What Defines an Advanced Airway
An advanced airway is a device inserted into the trachea, or windpipe, to secure a path for air to the lungs. They ensure the airway remains open for precise oxygen and ventilation delivery. Common examples include an endotracheal tube (ET tube), a flexible tube placed into the trachea, or a laryngeal mask airway (LMA), which sits above the vocal cords. Medical professionals, such as paramedics, doctors, or respiratory therapists, insert these devices in emergency or hospital settings.
The Key Differences in CPR Technique
When an advanced airway is in place, the approach to CPR shifts due to the secure and continuous ventilation it provides. The key change is continuous chest compressions. Unlike standard CPR, compressions continue uninterrupted at 100 to 120 per minute, without pausing for breaths.
Ventilations are delivered asynchronously, independent of chest compressions. One breath is administered every 6 seconds, or about 10 breaths per minute. This ensures constant blood flow to organs and adequate oxygenation. This coordinated effort requires at least two rescuers: one for continuous chest compressions, and another managing ventilations through the advanced airway.
The Rationale Behind the Changes
The rationale for these CPR changes with an advanced airway is to optimize blood flow and oxygen delivery to organs. Continuous chest compressions are emphasized because interruptions decrease coronary perfusion pressure, which drives blood flow to the heart. Uninterrupted compressions sustain consistent blood flow to the heart and brain, which are sensitive to oxygen deprivation.
The secure advanced airway allows asynchronous ventilations without concern for air leaking or gastric inflation. Delivering breaths every 6 seconds prevents hyperventilation, which can reduce blood return to the heart and decrease cardiac output. This approach ensures consistent oxygenation while maximizing chest compression effectiveness, improving the chances of a positive outcome.