Individuals with ineffective breathing patterns are considered to be in respiratory arrest and require immediate attention. There are many causes of respiratory arrest, including but not limited to cardiac arrest and cardiogenic shock. Resuscitate individuals in apparent respiratory arrest using either the BLS or the ACLS Survey.
Respiratory arrest is an emergent condition in which the individual is either not breathing or is breathing ineffectively.
Type of Ventilation
In Table 4, the airways listed in the left column are considered advanced airways, while those in the right column are basic airways. Although OPAs and NPAs are considered to be basic airways, they require proper placement by an experienced provider. Advanced airway insertion requires specialized training beyond the scope of ACLS certification. While the placement of advanced airways require specialized training, all ACLS providers should know the proper use of advanced airways once they are placed. Regardless of airway type, proper airway management is an important part of ACLS.
CPR is performed with the individual lying on their back; gravity will cause the jaw, the tongue, and the tissues of the throat to fall back and obstruct the airway. The airway rarely remains open in an unconscious individual without external support.
The first step in any airway intervention is to open the airway. This is accomplished by lifting the chin upward while tilting the forehead backThe goal is to create a straighter path from the nose to the trachea.
In individuals with suspected neck injury, the cervical spine should be protected and a jaw thrust alone is used to open the airway. While the standard practice in a suspected neck injury is to place a cervical collar, this should not be done in BLS or ACLS. Cervical collars can compress the airway and interfere with resuscitation efforts. The provider must ensure an open airway regardless of the basic airway used. The provider is obligated to stabilize the head or ask for assistance while maintaining control of the airway.
Do not over ventilate (i.e., give too many breaths per minute or too large volume per breath). Both can increase intrathoracic pressure, decrease venous return to heart, diminish cardiac output, as well as predispose individuals to vomit and aspiration of gastrointestinal contents.