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Airway management in cardiopulmonary resuscitation 

Airway management in cardiopulmonary resuscitation
Chapter:
Airway management in cardiopulmonary resuscitation
Author(s):

Jerry P. Nolan

and Jasmeet Soar

DOI:
10.1093/med/9780199600830.003.0059
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date: 27 November 2020

The most appropriate strategy for managing the airway during cardiopulmonary resuscitation (CPR) depends on the skills of the rescuer. Tracheal intubation is probably the optimal method for securing the airway, but only when undertaken by a highly-skilled individual. In the absence of a skilled intubator, insertion of a supraglottic airway device (SAD) is probably the best way of managing the airway during CPR. Some recent observation studies have suggested worse outcomes for cardiac arrest patients managed with a SAD compared with those receiving tracheal intubation. Such studies are likely to include hidden confounders and prospective randomized controlled trials are awaited. Use of waveform capnography is mandatory whenever tracheal intubation is attempted, but will also provide useful information about the effectiveness of CPR and an early indication of ROSC, even when used with a SAD. Once return of spontaneous circulation has been achieved, the inspired oxygen concentration should be titrated to achieve arterial blood oxygen saturation in the range 94–98%.

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