Cardiovascular Critical Care II
| (c) | Continuous chest compressions with asynchronous ventilation compared with chest |
|---|
compressions with interruptions for synchronous ventilation have not demonstrated improved
outcomes when delivered by emergency medical services (N Engl J Med 2015;23:2203-14).
Deliver each rescue breath over 1 second. Mouth-to-mouth, mouth-to-barrier, mouth-to-stoma,
and mouth-to-nose variations in initial rescue breathing are all acceptable and can achieve
adequate oxygenation and ventilation (Chest 1994;106:1806-10; Br J Anaesth 1964;36:542-9).
vi.
Positive-pressure ventilation
| (a) | Bag-mask ventilation |
|---|---|
| (1) | Components include a nonjam inlet valve, either no pressure relief valve or a pressure |
relief valve that can be bypassed, standard 15-mm/22-mm fittings, an oxygen reservoir
to allow for high oxygen delivery, and a non-rebreathing outlet valve (Respir Care
1992;37:673-90; discussion 690-4).
| (2) | Should not be used by a single rescuer. |
|---|---|
| (3) | Should use an adult bag (1 or 2 L) and deliver (two-thirds or one-third of bag |
volume, respectively) about 600 mL of tidal volume, which should produce chest
rise, oxygenation, and normocarbia (Resuscitation 2005;64:321-5; Resuscitation
2000;43:195-9).
| (4) | Quantitative waveform capnography with a bag-mask device to confirm and monitor |
|---|
CPR quality is now recommended. Prior to the 2020 guidelines, the recommendation
for quantitative waveform capnography monitoring was limited to monitoring
only after endotracheal tube placement (https://acls-algorithms.com/2021-aha-
acls-guideline-changes/adult-cardiac-arrest-algorithm-changes/)
| (b) | Supraglottic airway devices (e.g., King Airway device) are considered an acceptable |
|---|
alternative to bag-mask ventilation during cardiac arrest (assuming proper training is
supplied to rescuer) (Circ J 2009;73:490-6; Prehosp Emerg Care 1997;1:1-10).
| (1) | In OHCA, supraglottic airway devices may be associated with an increased rate of |
|---|
ROSC and faster time to airway placement, but survival outcomes are uncertain (Crit
| (2) | Supraglottic airway devices are considered within the scope of BLS in some |
|---|
geographical regions.
| (c) | See the ACLS section for more details and information regarding endotracheal intubation. |
|---|
vii.
Naloxone for opioid-related life-threatening emergencies: Has an independent algorithm in the
most recent guidelines (Circulation 2020;142(16_suppl_2):S366-468).
| (a) | Should be considered when a pulse is present but the patient has abnormal breathing or |
|---|
gasping (e.g., respiratory arrest).
| (b) | Can consider (in addition to BLS) administration of intramuscular or intranasal naloxone. |
|---|---|
| (c) | If patients lose their pulse, provision of CPR should commence with continued consideration |
of naloxone if opioid intoxication is suspected.
| (d) | Administer 0.4 mg intramuscularly or 2 mg intranasally diluted in 3 mL of normal saline |
|---|
β may repeat dose every 4 minutes.