Improving Airway and Breathing
Bag-mask airway management has traditionally been viewed
as inferior to endotracheal intubation; no prospective random-
ized trial has adequately addressed this question, however.
The OPALS study did not demonstrate mortality benefit from
the addition of ACLS, including endotracheal intubation, to
survival after out-of-hospital resuscitation.Insertion of an
endotracheal tube can be time consuming, interrupting chest
compressions and thereby halting cerebral blood flow at
times for
60 seconds. Unrecognized misplacement into the
esophagus can also occur. Therefore, the benefits of an
endotracheal tube in protecting the airway from aspiration
and ensuring air delivery to the lungs must be weighed
against these potential detriments. If undertaken, an advanced
airway should be placed rapidly by experienced rescuers,
with minimal interruption of chest compressions.Consideration should also be given to laryngeal mask airways
because of the ease and rapidity of their insertion.