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Airway techniques and ventilation strategies

Nolan, Jerry Pa; Soar, Jasmeetb

Current Opinion in Critical Care: June 2008 - Volume 14 - Issue 3 - p 279–286
doi: 10.1097/MCC.0b013e3282f85bc8
Cardiopulmonary resuscitation: Edited by Volker Wenzel

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.

aRoyal United Hospital, Bath, UK

bSouthmead Hospital, Bristol, UK

Correspondence to Jerry P. Nolan, FRCA, FCEM, Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital, Combe Park, Bath BA1 3NG, UK Tel: +44 1225 825056; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.