Podcast 33 - ApOx, Suctioning, & OOHA Airway Management
Lately I have received some really good questions and comments based off of my blog I did a few months ago "You're not dead until you have an airway."
Here are those comments:
"This seems to completely ignore the growing evidence that an airway during arrest is correlated with worse outcomes."
The mere presence of an established airway is not the problem with low CPC score or achievement of ROSC. The areas of advanced airway placement that I would speculate contribute to worse outcomes are.
1. Interruption in chest compressions to allow a provider to intubate.
2. Low resources and over ambition with airway as a priority rather than chest compressions and defibrillation.
3. Two hand bagging once an advanced airway is in place (decreased dead space.. increased ITP)
An OPA or NPA is an airway ADJUNCT. These should be used as a bridge in the initial stages of cardiac arrest until either an SGA or ETT can be placed.
This recent study shows higher complication rates when providers ONLY used airway adjuncts and BVM during cardiac arrest... go figure.
According to AHA 2015 Guidelines, continuous chest compressions can only be initiated once an advanced airway is placed. So it would make sense to place an advanced airway in a somewhat timely manner to avoid the need to stop every 30 compressions to deliver ventilations. This doesn't necessarily need to be an ET tube.
"Does this mean every person in whom we can’t place an ETT or SGA should receive a surgical airway?"
Depending on downtime.. my personal answer is yes. If your patient has obvious rigor due to a prolonged down time, then you aren't initiating resuscitation to begin with. If your patient has a locked jaw from reasons mentioned in the referenced blog.. why would you not secure an airway? This is purely opinion and obviously is not backed by anything but level 5 evidence.
"Does the DuCanto Catheter and SALAD technique affect ApOx?"
No, if demonstrated properly the catheter should rest in the esophagus and not extract an oxygen from the hypopharynx. During observation at the SALAD simulation in Vegas, I noticed some providers not tuck the tip of the catheter into the esophagus. While this may not be a huge issue if emesis production is steady, it could possibly cause a retrieval of oxygen from ApOx.
This video demonstrates the changes in oxygen distraction between the suction being placed in the pharynx vs. the esophagus.
All these questions and more answered in this episode!