Oxygenation, ventilation, and airway management in out-of-hospital cardiac arrest: a review.

Tomas Henlin,Pavel Michalek,Tomas Tyll,John D Hinds,Milos Dobias

doi:10.1155/2014/376871

Tomas Henlin, Pavel Michalek + Show 3 more

Open Access

https://doi.org/10.1155/2014/376871

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Abstract

Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

Highlights

Since the late 1950s, when Safar et al described the ABC principle in cardiopulmonary resuscitation [1, 2], the letters “A” and “B” have been the cornerstones of resuscitation in cardiac arrest
The latter option showed the lowest rates of survival to hospital admission and reduced survival to discharge from hospital
A prospective population-based study (All-Japan Utstein Registry) evaluated 649,359 patients with of-hospital cardiac arrest (OHCA) [56]. Primary outcome of this trial was neurological outcome related to different airway management technique during Cardiopulmonary resuscitation DO2 (CPR) and prehospital emergency care after restoration of spontaneous circulation (ROSC)

Summary

Introduction

Since the late 1950s, when Safar et al described the ABC principle in cardiopulmonary resuscitation [1, 2], the letters “A” (airway) and “B” (breathing, ventilation) have been the cornerstones of resuscitation in cardiac arrest. For many years, this algorithm remained unchanged. Opening the airway, delivering oxygen at 100% concentration, insertion of a tracheal tube, and application of intermittent positive pressure ventilation (IPPV) were considered “gold standards” in oxygenation and airway management This applied both during cardiopulmonary resuscitation for cardiac arrest in adults and in the early period after restoration of spontaneous circulation (ROSC). This has included the method of delivering oxygen, its ideal fraction, ventilation strategies, timing, and utilizing adjuncts other than a tracheal tube for maintenance of airway patency

Management during Resuscitation

Findings

Conclusions