Current concepts in airway management for cardiopulmonary resuscitation

To describe the methods of maintaining airway patency for oxygenation during cardiopulmonary resuscitation (CPR) that do not require expertise in mask ventilation or endotracheal intubation by direct laryngoscopy.

A review of rescue breathing and newer methods of providing airway patency is provided.

Airway patency during CPR is often difficult to achieve. Mask ventilation predisposes to hypoventilation and aspiration pneumonitis. Endotracheal intubation by direct laryngoscopy is the preferred method of maintaining airway patency for CPR. Alternative techniques for airway management include endotracheal intubation by lighted stylet, esophageal tracheal Combitube, laryngeal mask airway, and transtracheal ventilation. These methods are recommended by the American Heart Association and the American Society of Anesthesiologists. They have been approved by the Food and Drug Administration for maintenance of airway patency; they are easy to learn, effective, and applicable to CPR. Advantages and disadvantages of each technique may indicate or contraindicate one method over another in specific circumstances.

When CPR is compromised by airway obstruction that remains unresponsive to traditional techniques, using alternative methods is appropriate. The techniques selected must be based on individual familiarity and expertise.