Airway techniques and ventilation strategies.

PURPOSE OF REVIEW

To discuss the advantages and disadvantages of various methods of airway management during cardiopulmonary resuscitation. The role of ventilation during out-of-hospital cardiopulmonary resuscitation is also discussed.

RECENT FINDINGS

Prehospital studies fail to show any benefit from tracheal intubation during cardiopulmonary resuscitation and many show harm. Use of a supraglottic airway device may be preferable for rescuers who are not highly skilled in tracheal intubation. Bystander cardiopulmonary resuscitation increases survival rates from out-of-hospital cardiac arrest. Following a witnessed, sudden collapse, survival rates achieved when bystanders deliver compression-only cardiopulmonary resuscitation are at least the same as those achieved with cardiopulmonary resuscitation that includes mouth-to-mouth ventilation (rescue breathing). Some investigators have reported higher survival rates following the introduction of cardiocerebral resuscitation--a strategy that de-emphasizes ventilation during initial resuscitation by emergency medical services personnel.

SUMMARY

Supraglottic airway devices are a logical alternative to tracheal intubation when cardiopulmonary resuscitation is undertaken by individuals who are not highly skilled and experienced intubators. By teaching laypeople compression-only cardiopulmonary resuscitation, it is hypothesized that rates of bystander cardiopulmonary resuscitation, and therefore survival after out-of-hospital cardiac arrest, will increase.