critical care medicine
Cardiopulmonary Resuscitation (CPR) in Adults
Airway and Breathing
Opening the airway is the second priority (see Clearing and Opening the Upper Airway ) after beginning chest compressions. For witnessed out-of-hospital cardiac arrest with an initial shockable rhythm, it is acceptable to provide passive oxygenation for the first 6 minutes, as part of an emergency medical services bundle of care aimed at minimizing pauses in the initial provision of CPR and defibrillation. For mechanical measures regarding resuscitation in children, see table When health care professionals provide CPR, Bag-Valve-Mask Devices should be started as early as possible, but bag-valve-mask ventilation should not delay initiation of compressions or defibrillation. Lay rescuers may provide compressions-only CPR or, if trained to do so, may give rescue breaths delivered mouth-to-mouth (for adults, adolescents, and children) or combined mouth-to-mouth-and-nose (for infants). If available, an If abdominal distention develops, the airway is rechecked for patency, and the amount of air delivered during rescue breathing is reduced. Nasogastric intubation to relieve gastric distention is delayed until suction equipment is available because regurgitation with aspiration of gastric contents may occur during insertion. If marked gastric distention interferes with ventilation prior to availability of suction and cannot be corrected by the above methods, patients are positioned on their side, the epigastrium is compressed, and the airway is cleared. after initial CPR and defibrillation attempts, as described under Airway Establishment and Control . A breath is given every 6 seconds (10 breaths/minute) without interrupting chest compression in adults; infants and children are given breaths every 2 to 3 seconds (20 to 30 breaths/minute). However, chest compression and defibrillation take precedence over endotracheal intubation. Unless highly experienced rescuers are available, endotracheal intubation may be delayed in favor of ventilation with a For patients suspected of having COVID-19 , the American Heart Association released interim guidance for basic and advanced life support ( Use of personal protective equipment (PPE) appropriate for aerosol-generating procedures (respiratory protection against airborne and droplet particles, eye protection, gloves) for all people present in the treatment area during CPR or other advanced procedures (eg, intubation, chest decompression) Preference for endotracheal intubation or supraglottic airway placement over bag-valve-mask ventilation if this can be done without interrupting compressions Use of a HEPA (high efficiency particulate air [filter]) viral filter on bag-valve devices or ventilator exhalation circuits Use of a mechanical chest compression device if available This guidance aims to decrease the risk to the health care workers providing care during cardiac arrest. 1.Edelson DP, Sasson C, Chan PS, et al; American Heart Association ECC Interim COVID Guidance Authors: Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association.Circulation141(25):e933–e943, 2020. doi: 10.1161/CIRCULATIONAHA.120.047463 2.Goodloe JM, Topjian A, Hsu A, et al: Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic.Circ Cardiovasc Qual Outcomes14(7):e007666, 2021. doi:10.1161/CIRCOUTCOMES.120.007666 