In the Bag or Out of Control? BVM Revisited

In the bag or out of control? A recent article highlighting new changes to the comprehensive 2015 European Research Council (ERC) Guidelines for Resuscitation states that there’s “little new in how we should manage the airway in 2017.”1,2 The article references two studies that demonstrate increased use of, and better success rates with, videolaryngoscopy for endotracheal intubation (ETI), as well as another study showing that inexperienced providers can successfully perform cricothyroidotomies on fresh cadavers using pocket knives and ballpoint pens. Although the increasing use of video technology may lead to decreasing rates of unrecognized misplaced ETI, most systems probably won’t be incorporating pocket knives and ballpoint pens anytime soon. ETI or BVM? The guidelines state that though ETI provides the most reliable form of airway management, there are no randomized, controlled trials showing that its use leads to improved survival following cardiac arrest. They also suggest that, to limit interruptions in chest compressions during CPR, ETI can be delayed until return of spontaneous circulation (ROSC). Several limited observational studies are referenced, as is one meta-analysis, that demonstrate improved outcomes with use of bag-valve mask (BVM) ventilation when compared to advanced airway management with ETI or blind insertion supraglottic airway (SGA). Continuous end-tidal carbon dioxide waveform capnography (EtCO2) is recommended to confirm and monitor ETI, ...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Patient Care Columns Source Type: news