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January 16, 2013

Managing the Airway During Cardiac Arrest

Author Affiliations

Author Affiliations: Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham (Dr Wang); and Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Yealy).

JAMA. 2013;309(3):285-286. doi:10.1001/jama.2012.216998

For decades, an axiom of care in the resuscitation of cardiopulmonary arrest was “airway first.” Airway management seeks to maintain or create an open pathway to the lungs to ensure adequate oxygenation and ventilation, commonly using the strategy of bag-valve-mask ventilation. However, because maintaining an open pathway for gas exchange is difficult with this approach and does not protect the lungs from aspiration of gastric contents, more advanced airway maneuvers are often used. These techniques usually involve endotracheal intubation or supraglottic airway placement. The latter device is inserted blindly through the mouth, sealing the hypopharynx to facilitate oxygen delivery without a direct conduit through the glottis.