Optimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review

Best Pract Res Clin Anaesthesiol. 2021 May;35(1):67-82. doi: 10.1016/j.bpa.2020.11.003. Epub 2020 Nov 16.


Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. Endotracheal intubation can still be indicated, but has the largest downsides of all advanced airway techniques. Whichever stage of airway management, ventilation and chest compression quality should be closely monitored. Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.

Keywords: airway management; capnography; cardiopulmonary resuscitation; out-of-hospital cardiac arrest; prehospital advanced life support; ventilation.

Publication types

  • Review

MeSH terms

  • Advanced Cardiac Life Support / methods
  • Advanced Cardiac Life Support / standards*
  • Airway Management / methods
  • Airway Management / standards*
  • Cardiopulmonary Resuscitation / methods
  • Cardiopulmonary Resuscitation / standards
  • Emergency Medical Services / methods
  • Emergency Medical Services / standards*
  • Humans
  • Intubation, Intratracheal / methods
  • Intubation, Intratracheal / standards
  • Manikins
  • Out-of-Hospital Cardiac Arrest / diagnosis
  • Out-of-Hospital Cardiac Arrest / physiopathology
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Respiration, Artificial / methods
  • Respiration, Artificial / standards*