CPR and Intubation

[tcripp]

When you have an arrest and you are ready to intubate, do you make an effort to intubate while chest compressions are still happening or do you have everyone stop so you can get the tube?

[Bernhard]

To workaround the whole problem, I suggest a larynx tube (LT) as a real fast airway without need to interrupt anything. I put a LT in as soon as starting with a bag valve and use an e.t. tube only if really needed: if LT doesn't work for some reason or during transport when we use automatic respirator and/or mechanical compression system, requiring e.t. intubation. Since we may declare death on scene, we don't transport every arrest.

Then, our process for e.t. intubation usually is: do it during compression and only if this doesn't work, order a short break (seconds) for twiddling your tube in. All the preparing and trying to get a good view always could be done during compressions, as well as blocking, checking and fixing.

Edited June 23, 2011 by Bernhard

[tcripp]

Then, our process for e.t. intubation usually is: do it during compression and only if this doesn't work, order a short break (seconds) for twiddling your tube in. All the preparing and trying to get a good view always could be done during compressions, as well as blocking, checking and fixing.

Bernhard, thank you for your reply. I recently ran in to several who's take on it is that you stop compressions to insert the ET tube. Since that is not how I learned it, I was curious if there were others of the same mindset. It will be interesting to see other posts.

Was recently in your fair State of Bavaria. BEAUTIFUL country.

[HellsBells]

Typically I intubate with compressions. I dont find it difficult on the typical pt and i was taught that compressions are paramount in a cardiac arrest.

[DwayneEMTP]

... for twiddling your tube in....

Can you say that here?

I was also taught to stop compressions to intubate, I've just chosen not to follow that training as it just doesn't make sense to me. So, yeah, if you can do it safely with compressions then I believe that is certainly the best option. If though, for whatever reason, you can't, then the briefest possible pause is warranted. Stopping compressions is bad but trying to be macho and creating airway damage could certainly be worse.

I don't believe that this is a 'one answer fits all' question.

Dwayne

[tcripp]

I don't believe that this is a 'one answer fits all' question.

Can't imagine it would...just curious to see how others practice this skill.

[DwayneEMTP]

Can't imagine it would...just curious to see how others practice this skill.

Yeah, upon rereading my response I'm sorry I made it sound like I believed that you were looking for a one fit answer as opposed to polling and trying to generate discussion.

You've never been a shallow provider and I didn't mean to imply that you were looking for so simple an answer.

Just not well phrased on my part.

Dwayne

[tcripp]

Just not well phrased on my part.

Dwayne

No worries, my friend. No worries.

I guess I spend more of my posts trying to figure out how others "do it" so that I can see if what I am doing can be improved upon. Since I am a solo medic on a truck, I don't get insight in to how others work.

[croaker260]

I typically intubate DURING compressions. To maximise my chance of success, I go in with the Bougie on my first attempt, difficult airway or not. I tend to have good success with this approach.

Intubating during compressions is recommended in the new 2010 guidelines as well as (some) renewed emphasis on ETT as at lease one study showed improved survival to hospital discharge with ETT (though no improvement in ROSC).

[usalsfyre]

BIAD during CPR, if an ROSC is achieved I'll pull it an intubate. If I have to tube during the CPR, it's while compressions are ongoing.

Edited June 24, 2011 by usalsfyre