Airway techniques and ventilation strategies.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Nolan
Jerry P
JP
Royal United Hospital, Bath, UK. Jerry.nolan@ruh.nhs.uk
Soar
Jasmeet
J
D016887:Cardiopulmonary Resuscitation; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D012121:Respiration, Artificial