Quick Answer
You should consider using an advanced airway during CPR if the patient is a child or infant, has a difficult airway, or if you have a provider who is trained and competent in advanced airway management, such as an endotracheal tube.
Advanced Airway Indications
When considering the use of an advanced airway during CPR, it’s essential to assess the patient’s airway, breathing, and circulation (ABCs). If the patient has a difficult airway, such as a narrow airway or an airway with a lot of secretions, an advanced airway may be necessary to secure the airway and facilitate effective ventilation. This is particularly true in pediatric patients, where the airway is smaller and more fragile.
Advanced Airway Techniques
For adult patients, a bag-valve-mask (BVM) device is generally sufficient for CPR ventilation. However, if an advanced airway is needed, the preferred method is toinsert an endotracheal tube (ETT) using direct laryngoscopy. This technique involves using a laryngoscope to visualize the vocal cords and then passing the ETT through the vocal cords and into the trachea. The ETT should be secured with tape and connected to a bag-valve-mask device or a mechanical ventilator.
Advanced Airway Training and Competency
Before attempting to use an advanced airway during CPR, all providers involved in the resuscitation should be trained and competent in advanced airway management. This includes the ability to assess the airway, perform direct laryngoscopy, and insert an ETT. According to the American Heart Association (AHA), at least one provider should be trained and competent in advanced airway management before attempting to use an advanced airway during CPR.
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