Airway Management in Cardiac Arrest

Key Considerations

The American Heart Association recommends that skilled providers with frequent experience or regular retraining can perform endotracheal intubation safely during cardiac arrest (Class I, LOE B) 1
Inexperienced providers attempting intubation produce unacceptably high complication rates, including prolonged interruptions in chest compressions, unrecognized esophageal intubation, tube displacement, and hypoxemia from prolonged attempts 1, 3
The American Heart Association suggests that EMS systems performing prehospital intubation must provide ongoing quality improvement programs to minimize complications (Class IIa, LOE B) 1

Interruptions in chest compressions must be limited to less than 10 seconds for laryngoscopy and tube passage through the vocal cords 1, 4
The intubating provider must be fully prepared with the laryngoscope blade and tube ready before compressions are paused 1
Chest compressions should resume immediately after the tube passes through the vocal cords 1

The American Heart Association recommends that either bag-mask device or advanced airway may be used for oxygenation and ventilation during CPR in both in-hospital and out-of-hospital settings (Class IIb, LOE C-LD) 2
Supraglottic airway devices or endotracheal tubes may be used as the initial advanced airway during CPR (Class IIb, LOE C-LD) 2
The laryngeal mask airway is an acceptable alternative to bag-mask ventilation (Class IIa, LOE B) or endotracheal intubation (Class IIa, LOE C) for healthcare professionals trained in its use 1, 3

Deliver 10 breaths per minute with continuous compressions once advanced airway is placed 7
Avoid hyperventilation, which compromises venous return and causes hypotension 8
Target normocapnia (PaCO2 35-40 mmHg) 8, 6

Conventional CPR with ventilations and compressions is superior to compression-only CPR for pediatric asphyxial arrest 11
Bag-mask ventilation with manual airway maneuvers is recommended for short periods in out-of-hospital settings 11
Supraglottic airways may be helpful when bag-mask ventilation is ineffective 11