Management of Subcutaneous Emphysema Post Cardiac Arrest

Airway Management

The American Heart Association recommends securing the airway with endotracheal intubation if not already in place, and using waveform capnography to confirm and continuously monitor tube placement, with a strength of evidence based on expert opinion 1, 2, 3, 4
The American Heart Association suggests avoiding excessive tidal volumes that may worsen air leaks, with a strength of evidence based on moderate-quality evidence 2, 5

The American Heart Association recommends using low tidal volume ventilation (6-8 mL/kg predicted body weight) and maintaining normocapnia with PaCO2 40-45 mmHg or PETCO2 35-40 mmHg, with a strength of evidence based on high-quality evidence 2, 6
The American Heart Association suggests avoiding hyperventilation which may worsen subcutaneous emphysema and cause cerebral vasoconstriction, with a strength of evidence based on moderate-quality evidence 2, 5
The Society of Critical Care Medicine recommends applying appropriate PEEP (4-8 cm H2O) to prevent atelectasis while avoiding excessive airway pressures, with a strength of evidence based on moderate-quality evidence 6

The American Heart Association recommends providing adequate sedation and analgesia to improve patient-ventilator synchrony, with a strength of evidence based on moderate-quality evidence 2, 5
The American Heart Association suggests considering short-term neuromuscular blockade if patient agitation is compromising ventilation, with a strength of evidence based on low-quality evidence 2, 5

The American Heart Association recommends continuously monitoring respiratory parameters including oxygen saturation, end-tidal CO2, and ventilatory pressures, with a strength of evidence based on high-quality evidence 1, 4