Cardiopulmonary Resuscitation: To Intubate or Not to Intubate
Cardiopulmonary resuscitation is a “tug of war” between life and death. The most suspenseful
and technically difficult task in the resuscitation process is often endotracheal intubation.
However, the benefits of endotracheal intubation during CPR
have been seriously challenged in recent literature.
Establishment of an advanced airway to maintain gas exchange and oxygenation has been
viewed as an essential life-saving procedure during resuscitation.
Over the past few decades, clinicians have taken for granted the importance of such practice, despite
lack of high-quality evidence. However, since the late 1990s, our fundamental understanding
of cardiopulmonary resuscitation has changed significantly.
The quality of chest compressions has been found to be the most important factor
leading to a successful cardiopulmonary resuscitation. Any interventions that may interrupt
chest compressions during CPR, such as central venous catheter cannulation, bedside echocardiography,
and cardiac rhythm check, should be minimized.
Tracheal intubation during resuscitation is a dilemma. On one hand, airway patency is the key to effective ventilation, but on the other tracheal intubation during CPR is technically challenging.
Observational studies have reported a nearly 15% failure rate for the first intubation attempt, and the failure rate can be as high as 50% for pediatric patients.
2,3 Failure of tracheal intubation can result in a prolonged interruption of chest compression.
Even if tracheal intubation is successful, hyperventilation is a frequent complication which can lead to failure of cardiopulmonary resuscitation. It may also lead to elevated.
Emerg Med Open J. 2018; 4(1): e1-e3. doi: 10.17140/EMOJ-4-e005
