22.9b Foreign Body Removal with Laryngoscopy + Airway Management in Cardiac Arrest

When confronted with a patient who has apparently choked on a foreign object or substance, you should initially carry out basic maneuvers, such as abdominal thrusts or chest thrusts, for airway obstruction that are appropriate to the patient’s age and mental status.

If these fail to alleviate the obstruction, visualization of the airway with a laryngoscope can enable you to remove an obstructing foreign body using Magill forceps or a suction device (Figure 22-106).

The procedure for visualizing the airway is identical to that used for orotracheal intubation, discussed earlier.

Although many EMS agencies are moving to using an extraglottic airway in cardiac arrest, intubation is still a common strategy.

It is imperative that EMS practitioners focus on the interventions shown to improve survival from cardiac arrest, namely high-quality, minimally interrupted chest compressions and early defibrillation.

Excess focus on early intubation can distract from these priorities and decrease survival.

Because of this, a choreographed team approach to cardiac arrest is vital.

There are several modifications to airway management for a patient in cardiac arrest.

One is the use of an extraglottic device instead of intubation.

Research shows that survival is at least as good, if not better, with this strategy.

Regardless of the airway device used, early resuscitation should be with a BVM only to establish effective compressions and early defibrillation.

Many, if not most, cardiac arrest airways are soiled with blood and other contaminants, so early and aggressive suctioning is vital.

The use of automated compression devices is likely to worsen oropharyngeal bleeding, suggesting that airway management should usually occur prior to their application.

Most important, placement of an advanced airway device should never interfere with chest compressions.

Because intubation requires visualization of the glottic opening, it is more challenging to achieve with ongoing chest compressions than the use of an extraglottic device.

The use of a bougie and/or video laryngoscopy with a hyperacute geometry blade is an important strategy to allow successful intubation without compression interruption.

Placement confirmation is just as important in cardiac arrest as it is in other patients.

There was once concern that end-tidal might not be useful in cardiac arrest because of low cardiac output.

This has been disproven with several cadaver studies showing detection of long after death.

Because of this, should be measured in the cardiac arrest patient to confirm placement with either an endotracheal tube or an extraglottic device.