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Advanced Airway Adjuncts

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The endotracheal tube is an advanced airway alternative. It is a specific type of tracheal tube that is inserted through the mouth or nose. It is the most technically difficult airway to place; however the most secure airway available. Only experienced providers should perform endotracheal intubation. This technique requires the use of a laryngoscope. Fiberoptic portable laryngoscopes have a video screen, improve success, and are gaining popularity for field use.


The laryngeal mask airway is an advanced airway alternative to endotracheal intubation and provides comparable ventilation. It is acceptable to use the laryngeal mask airway as an alternative to an esophageal-tracheal tube for airway management in cardiac arrest. Experience will allow rapid placement of the LMA device by an ACLS provider.


The advantages of the laryngeal tube are similar to those of the esophageal-tracheal tube; however, the laryngeal tube is more compact and less complicated to insert. This tube has only one larger balloon to inflate and can be inserted blindly.


The esophageal-tracheal tube (sometimes referred to as a “combitube”) is an advanced airway alternative to endotracheal intubation. This device provides adequate ventilation comparable to an endotracheal tube. The combitube has two separate balloons that must be inflated and two separate ports. The provider must correctly determine which port to ventilate through to provide adequate oxygenation.

  • During CPR, the chest compression to ventilation ratio is 30:2.
  • If advanced airway is placed, do not interrupt chest compressions for breaths. Give 1 breath every 6 – 8 seconds.
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