Nov 3, 2017
Lately I have received some really good questions and comments based off of my blog I did a few months ago "You're not dead until you have an airway." Here are those comments: "This seems to completely ignore the growing evidence that an airway during arrest is correlated with worse outcomes." The mere presence of an established airway is not the problem with low CPC score or achievement of ROSC. The areas of advanced airway placement that I would speculate contribute to worse outcomes are. 1. Interruption in chest compressions to allow a provider to intubate. 2. Low resources and over ambition with airway as a priority rather than chest compressions and defibrillation. 3. Two hand bagging once an advanced airway is in place (decreased dead space.. increased ITP) A OPA or NPA is an airway ADJUNCT. These should be used as a bridge in the initial stages of cardiac arrest until either an SGA or ETT can be placed. This recent study shows higher complication rates when providers ONLY used airway adjuncts and BVM during cardiac arrest... go figure. http://www.mdedge.com/ecardiologynews/article/150634/arrhythmias-ep/bag-mask-ventilation-cpr-deflates-large-rct According to AHA 2015 Guidelines, continuous chest compressions can only be initiated once an advanced airway is placed. So it would make sense to place an advanced airway in a somewhat timely manner to avoid the need to stop every 30 compressions to deliver ventilations. This doesn't necessarily need to be an ET tube. Check out the blog! https://www.foamfrat.com/single-post/2017/11/03/ApOx-Suction-and-OOHA-Airway-Management