Part 7.1: Adjuncts for Airway Control and Ventilation

Abstract

This section highlights recommendations for the support of ventilation and oxygenation during resuscitation and the periarrest period. The purpose of ventilation during CPR is to maintain adequate oxygenation and sufficient elimination of carbon dioxide, but research has not identified the optimal tidal volume, respiratory rate, and inspired oxygen concentration required to do so. During the first minutes of ventricular fibrillation sudden cardiac arrest (VF SCA), rescue breaths are probably not as important as chest compressions, because oxygen delivery to the tissues, including the heart and brain, appears to be limited more by blood flow than by arterial oxygen content. Thus, during the first minutes of VF SCA the lone rescuer should attempt to limit interruptions in chest compressions for ventilation. The advanced provider must be careful to limit interruptions in chest compressions for attempts to insert an advanced airway or check the rhythm. Ventilation and compressions are both thought to be important for victims of prolonged VF SCA and for all victims of asphyxial arrest (eg, drowning victims and victims of drug overdose with primary respiratory arrest) because these victims are hypoxemic before arrest. Because systemic and, therefore, lung perfusion is substantially reduced during CPR, rescuers can support a normal ventilation-perfusion match with a minute ventilation that is much lower than normal. During CPR with an advanced airway in place we now recommend a lower rate of rescue breathing (see Part 4: “Adult Basic Life Support”) than that recommended in the ECC Guidelines 2000 .1 During the prearrest and postarrest periods, the patient will require support of oxygenation and ventilation with tidal volumes and respiratory rates that more closely approximate normal. Beyond the first minutes of cardiac arrest, tissue hypoxia develops. CPR provides approximately 25% to 33% of normal cardiac output. This low-flow state maintains a small but critical …