Paramedics sometimes interrupt CPR to open airway
Research Activities, June 2010, No. 358
Current guidelines recommend continuous, uninterrupted chest compressions during cardiopulmonary resuscitation (CPR). However, paramedics sometimes interrupt CPR chest compressions in order to insert a breathing tube (endotracheal intubation) into the patient's airway.
A new study found that paramedics interrupted CPR at least twice for a total of 2 minutes during endotracheal intubation efforts. This finding adds support to efforts to deemphasize out-of-hospital intubation and delay it until later in resuscitation efforts, note the researchers. They studied CPR interruptions among 100 patients with out-of-hospital cardiopulmonary arrests who were treated by paramedics. Compression sensors attached to cardiac monitors in the ambulance continuously recorded all delivered CPR chest compressions. All of the resuscitation events were recorded on a digital audio channel. A chest compression interruption was defined as 5 seconds or longer.
On average, there were two CPR interruptions for every patient treated. More than a third of patients had more than two interruptions. Some patients experienced as many as nine interruptions. An average of 46.5 seconds elapsed during the first interruption. Almost a third lasted more than 1 minute, with a few interruptions lasting close to 4 minutes. Second interruptions were briefer, running an average of 35 seconds in duration. The average total duration of all interruptions was 109.5 seconds. A quarter of these lasted more than 3 minutes. The researchers determined that 22 percent of all CPR interruptions were the result of paramedics' efforts to insert an airway tube. The study was supported in part by the Agency for Healthcare Research and Quality (HS13628).
See "Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation," by Henry E. Wang, M.D., M.S., Scott J. Simeone, B.S., Matthew D. Weaver, B.S., and Clifton W. Callaway, M.D., Ph.D., in the November 2009 Annals of Emergency Medicine 54(5), pp. 645-652.