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.64 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.76 Consid¬eration should also be given to laryngeal mask airways because of the ease and rapidity of their insertion.