Change in CPR policy

Silverlight2010 · May 23, 2012

That's weird. Why not intubate if needed?

Double-Helix, BSN, RN · May 23, 2012

The AHA's recommendation of CAB does not address intubation.

CPR is part of BLS. Intubation is part of ACLS. Your hospital should still be using the latest ACLS procedures when performing a code.

The biggest misconception about CAB is that it re-prioritizes your medical assessment. Not true. It addresses CPR, and CPR only. And all it addresses regarding CPR is that chest compressions should be initiated as the first action, rather opening the airway and rescue breathing. You still assess for breathing and pulse in the initial step. Then, if the patient is not breathing and has no pulse, you initiate CPR, starting with chest compressions. Then you open the airway, give breaths, and continue compressions.

The reason for this is that most cardiac arrests are sudden. There is still usable oxygen in the blood, but the blood is not being circulated. The biggest problem for the patient at that moment is that the vital organs (specifically heart and brain) are not being perfused. In order to insure the best outcome, the perfusion of these organs needs to be returned as soon as possible to prevent cardiac and brain death. Since there is still usable oxygen in the blood, the patient's highest need at the initiation of CPR is chest compressions, not oxygen.

Again, this has nothing to do with intubation, so it makes absolutely no sense that your hospital would remove intubation from the code policy based on the CAB recommendation.

Mommy&RN, BSN, RN · May 23, 2012

That was what I thought. This particular code had respiratory therapy there as well as the code team and the attending cardiologist.RT told the primary RN that they don't Intubate Automaticaly. I will have to pull the policy when I go back to work. I didn't think it sounded right, so I wanted to see if this was happening elsewhere.

Perpetual Student · May 23, 2012

I think there was some miscommunication here. It's not that you don't ever intubate, it's that if you're ventilating well with the BVM you should keep doing that and focus on compressions, shocks, etc. until you hopefully stabilize the patient. The ETT in and of itself doesn't really do much for the patient--it's just one tool to maintain and protect the airway.

Double-Helix, BSN, RN · May 24, 2012

I think there was some miscommunication here. It's not that you don't ever intubate, it's that if you're ventilating well with the BVM you should keep doing that and focus on compressions, shocks, etc. until you hopefully stabilize the patient. The ETT in and of itself doesn't really do much for the patient--it's just one tool to maintain and protect the airway.

That's a good clarification. There's a big difference between not ever intubating, and intubating when the patient is less unstable. If there is a non-perfusing rhythm, then all the time it takes to get the tube ready, tongue blade in place, visualize the chords, insert the tube and check placement is time that the patient is going without perfusion to the heart and brain. So in that case it absolutely makes sense that you would bag the patient until you've got a perfusing rhythm and then intubate if indicated.

The real benefit of the ET tube during a code is that you can ventilate and provide compressions continuously and simultaneously. If you are using a BVM, you need to break compressions after each cycle of 30 in order to ventilate.