techniques to manage airway during cardiac arrest

1. ADJUNCTS FOR
AIRWAY CONTROL, VENTILATION
AND SUPPLEMENTAL OXYGEN
Objectives
1. To control the airway properly during cardiac arrest
2. To optimize ventilation
3. To use airway adjuncts properly and effectively
4. To provide supplemental oxygen properly and effectively

2. 1
Open airway
by

3. OPEN AIRWAY
( Head - tilt / chin - lift / jaw - thrust )
No respirations Spontaneous respirations
present present
VENTILATE WITH KEEP AIRWAY OPEN
SUPPLEMENTAL OXYGEN AND MONITOR PATIENT
Mouth-to-Mask, B-V-M
No chest
expansion
INSERT PHARYNGEAL
AIRWAY (oral or nasal)
Foreign body
obstruction
VENTILATE
ENDOTRACHEAL INTUBATION
(as soon as possible)

4. AIRWAY CONTROL
Airway Obstruction
•Tongue and/or
•Epiglottis

5. AIRWAY CONTROL
Opening the Airway
Jaw thrust Head tilt–chin lift

6. AIRWAY CONTROL
Oropharyngeal Airway

7. AIRWAY CONTROL
Oropharyngeal Airway (cont.)

8. AIRWAY CONTROL
Oropharyngeal Airway (cont.)

9. AIRWAY CONTROL
Oropharyngeal Airway (cont.)

10. AIRWAY CONTROL
Oropharyngeal Airway (cont.)

11. AIRWAY CONTROL
Nasopharyngeal Airway

12. AIRWAY CONTROL
Nasopharyngeal Airway (cont.)

13. AIRWAY CONTROL
Nasopharyngeal Airway (cont.)

14. ENDOTRACHEAL INTUBATION
Advantages
• Protection of the airway from aspiration of
foreign material
• Facilitates ventilation and oxygenation
• Facilitates suctioning of trachea and bronchi
• Provides route for drug administration
• Prevents gastric insufflation
• Allows faster rate of chest compression

15. ENDOTRACHEAL INTUBATION
Indications
• Inability to ventilate the unconscious patient
• After insertion of pharyngeal airway
• Inability of patient to protect own airway
(coma, areflexia, or cardiac arrest)
• Need for prolonged artificial ventilation

16. ENDOTRACHEAL INTUBATION
Equipment
• Laryngoscope with several blades
• Endotracheal tubes
• Malleable stylet
• 10-ml syringe
• Magill forceps
• Water soluble lubricant
• Functional suction unit

17. ENDOTRACHEAL INTUBATION
Laryngoscope & Blades

18. ENDOTRACHEAL INTUBATION
Laryngoscope (cont.)
Connection of blade to handle

19. ENDOTRACHEAL INTUBATION
Endotracheal tube

20. ENDOTRACHEAL INTUBATION
Endotracheal tube (cont.)
Stylet

21. ENDOTRACHEAL INTUBATION
Aligning Axes of Upper Airway
Mouth
A
A B
B
C
C
Pharynx
Trachea
Extend-the-head-on-neck (“look up”): aligns axis A relative to B
Flex-the-neck-on-shoulders (“look down”): aligns axis B relative to C

22. ENDOTRACHEAL INTUBATION

23. ENDOTRACHEAL INTUBATION

24. ENDOTRACHEAL INTUBATION

25. ENDOTRACHEAL INTUBATION

26. ENDOTRACHEAL INTUBATION
Recommendations
• Intubate as soon as possible after ventilation
and oxygenation, in cardiac arrest
• Intubation should be done by most
experienced person
• Do not take longer than 30 seconds
• Auscultate the thorax and epigastrium after
intubation

27. ENDOTRACHEAL INTUBATION
Complications
• Trauma-teeth, lips, tongue, mucosa,
vocal cords, trachea
• Esophageal intubation
• Vomiting and aspiration
• Hypertension and arrhythmias

28. OXYGENATION AND VENTILATION
Mouth-to-mask
Advantages
• Elimination of direct contact
• Adequate lung ventilation
• Enriched oxygen mixture
• Easier than bag-valve-mask

29. OXYGENATION AND VENTILATION
Mouth-to-mask (cont.)
Mouth-to-mask device

30. OXYGENATION AND VENTILATION
Mouth-to-mask (cont.)
Technique

31. OXYGENATION AND VENTILATION
Bag-Valve-Mask
Advantages
• Provides immediate ventilation and oxygenation
• Sense of compliance and airway resistance
conveyed to operator
• Ideal method of ventilation after intubation
• High oxygen concentrations are possible
• Can be used with spontaneous respirations

32. OXYGENATION AND VENTILATION
Bag-Valve-Mask (cont.)
With oxygen reservoir

33. OXYGENATION AND VENTILATION
Bag-Mask Ventilation
• Key—ventilation volume: “enough to produce
obvious chest rise”
1-Person: 2-Person:
difficult, less effective easier, more effective

34. OXYGENATION AND VENTILATION
Bag-Valve-Mask (cont.)
Complications
• Inadequate tidal volumes
leading to hypoventilation
• Gastric distension

35. OXYGENATION AND VENTILATION
Manually Triggered Oxygen Powered
Breathing Device
• Allow for positive pressure ventilation
• Deliver 100% oxygen concentration
• Should provide a constant flow at 40 L/min
• Should have a relief valve that opens at 60 cmH2O

36. SUCTION DEVICES

37. TRACHEOBRONCHIAL SUCTIONING
Techniques
• Check equipment
• Set pressure between –80 to –120 mmHg
• Pre-oxygenate with 100% O2 for
five minutes
• Use sterile technique
• Insert suction catheter through the tube
• Apply suction and remove the catheter with
a rotation motion
• Suction no longer than 10 seconds

38. OTHER ADJUNCTS & TECHNIQUES
Cricoid Pressure

39. Esophageal-Tracheal Combitube
A = esophageal obturator; ventilation into trachea through side openings = B
E C = tracheal tube; ventilation through open end if proximal end inserted in trachea
D = pharyngeal cuff; inflated through catheter = E
Distal End
F = esophageal cuff; inflated through catheter = G
H = teeth marker; blindly insert Combitube until marker is at level of teeth
A
C
H Proximal End
B
D
F
G

40. Esophageal-Tracheal Combitube
Inserted in Esophagus
A
H
D
D
B F
A = esophageal obturator; ventilation into
trachea through side openings = B
D = pharyngeal cuff (inflated)
F = inflated esophageal/tracheal cuff
H = teeth markers; insert until marker lines at
level of teeth

41. Laryngeal Mask Airway (LMA)
The LMA is an adjunctive airway that consists of a
tube with a cuffed mask-like projection at distal end.

42. LMA Introduced Through Mouth
Into Pharynx

43. LMA in Position
Once the LMA is in position, a clear, secure airway is present.

44. Anatomic Detail

45. Esophageal Detector Device
(Bulb-Type)

46. Confirmation:
Tracheal Tube Placement
End-tidal colorimetric CO2 indicators

47. Tracheal Tube Holders:
Adult and Infant

48. Colorimetric End-Tidal
CO2 Detector

49. End-Tidal CO2 Detector
connected to Bag-valve-mask