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February 7, 2017

Whether to Intubate During Cardiopulmonary Resuscitation: Conventional Wisdom vs Big Data

Author Affiliations
  • 1Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Associate Editor, JAMA
JAMA. 2017;317(5):477-478. doi:10.1001/jama.2016.20626

For 60 years, health care professionals and lay bystanders have saved the lives of individuals with cardiac arrest through successful deployment of cardiopulmonary resuscitation (CPR). Although the 2010 American Heart Association CPR guidelines changed from the traditional “ABC” (airway-breathing-circulation) to “CAB” (circulation-airway-breathing) to ensure that rescue personnel are not unduly distracted from the prompt provision of optimal chest compressions, the core elements have largely remained unchanged.1 The definitive approach to secure and protect the airway and hence deliver effective breathing is via emergency endotracheal intubation by a suitably trained professional followed by institution of artificial ventilation. If no individual skilled in endotracheal intubation is available, then airway management via a bag-valve-mask device is an acceptable interim alternative. Because of the large number of in-hospital cardiac arrests, hospitals arrange, often at considerable cost, to have around-the-clock emergency response teams capable of providing advanced cardiac life support (ACLS), including endotracheal intubation.

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