Airway Management

• Explain and demonstrate the use of the following airway management adjuncts:
  • Oropharyngeal Airway
  • Nasopharyngeal Airway
  • Bag-valve mask apparatus
• Discuss types of Supraglottic Airway Devices (SADs)
• Describe the Laryngeal Mask Airway (LMA)
• Outline the technique for placement of a LMA
• Discuss safe management of a LMA
• Describe the endotracheal tube and correct positioning of same
• Discuss the intubation procedure
• Outline complications associated with intubation
• Demonstrate the role of the assistant during intubation
• Discuss the role of waveform capnography
• Discuss cricothyroidotomy
• Outline extracorporeal cardiopulmonary resuscitation – eCPR

• Unconscious
• Has an obstructed airway
• Needs rescue breathing

Without a patent airway, oxygen (O₂) delivery is impaired or prevented.  It is vital to get oxygen to the tissues if resuscitation is going to be successful.  A variety of airway management techniques and devices can be used to obtain and maintain the airway, facilitate ventilation with high oxygen concentrations and provide access to the airway to enable adequate suctioning of secretions.

ANZCOR Guideline 11.6, 2021

• Head tilt/chin lift
• Jaw thrust
• Bag-valve-mask device
• Oropharyngeal and nasopharyngeal airways
• Supraglottic airway devices (e.g. Laryngeal Mask Airway; i-gel Airway)
• Endotracheal intubation

Basic airway techniques are crucial elements in obtaining and maintaining airway patency.  These techniques include head tilt/chin lift and jaw thrust manoeuvres.  Positioning of the patient’s airway is essential to maintain airway patency throughout the resuscitation and is to be implemented irrespective of the presence of an oropharyngeal or nasopharyngeal airway.  Prompt assessment, control of the airway and ventilation are essential to prevent hypoxic damage to the brain and other vital organs.

Administer O₂ as soon as possible to maximise arterial blood O₂ saturation.  Rescue breathing (expired air) has an O₂ concentration of 15-17%; supplemental O₂ (as close to 100% as possible) is to be implemented as soon as available.

At all times, the decision on how best to provide airway management must be made with attention directed to the following factors:

• Availability of airway devices at the location
• Minimising interruptions to CPR during all resuscitation procedures
• Administering 100% oxygen to the victim when possible
• Considering appropriate airway adjuncts, mindful of training and experience of rescuers present, ensuring attempts to secure airway does not interrupt CPR for more than 5 seconds
• O₂ saturation (SpO₂) should be monitored where possible by pulse oximetry or arterial blood gas analysis (SaO₂)
• Pulse oximeter usually reads within ± 2%, however in the setting of poor perfusion, vasoconstriction, hypothermia, carbon monoxide etc, the reading with be substantially less accurate
• Generally aim to achieve a target O₂ saturation of 94 – 98%
• In the case of paraquat poisoning or bleomycin lung injury routine O₂ use is not recommended, however it is recommended O₂ is administered to achieve an O₂ saturation of 88 – 92%
• For patients with hypercapnic respiratory failure it is recommended O₂ is administered to achieve an O₂ saturation of 88 – 92%

There is insufficient evidence to define optimal timing for placement of an advanced airway during cardiac arrest.  A stepwise approach to airway management and ventilation using a combination of techniques is suggested.

To avoid significant interruptions to chest compressions rescuers may defer attempts at insertion of airway adjuncts until the patient has return of spontaneous circulation (ROSC).  It is recommended that waveform capnography is used to confirm airway placement and monitor the adequacy of CPR.  ANZCOR guideline 11.2, 11.6 2021