Effective ventilation during cardiac arrest

Published Date: 19th July 2016

Publication Authors: Young S, Bolton N,

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INTRODUCTION

Despite ALS training, management of the airway during in-hospital cardiac arrests often appears poorly performed by the non-anaesthetist.

OBJECTIVES

To assess the competency of junior doctors airway skills in the cardiac arrest scenario.

METHODS

We conducted an assessment of foundation year 1 (FY1) doctors´ management of the airway in a simulated cardiac arrest scenario using a standard 'Resus Annie' mannequin. Over an 8 week period we assessed 26 of the 35 (74%) available FY1 doctors working at a district general hospital. We reviewed their ability to set up an ambu-bag, connect it to oxygen within one cycle of CPR and thereafter deliver effective ventilation as per ALS guidelines.

RESULTS

27% set up a self-inflating bag within one cycle of CPR but of the total, only 15% attached the ambu-bag to the wall or cylinder oxygen supply. 65% managed to deliver the minimum of 2 effective breaths in 5 seconds (new guidelines) or deliver 2 effective ventilations of 5 attempts (old guidelines). All FY1 doctors audited were aware of appropriate airway adjuncts.

CONCLUSIONS

The results indicate that there is a substantial gap in practical knowledge of how to manage the airway of a patient in emergency situations Another cause for concern was only 65% were able to deliver effective breaths in the time allowed. It is well known that in any review of a patient the airway is priority. It is therefore the first clinician on scene who will need to be able to manage the airway of a patient. Currently, most FY1 doctors are ALS providers, however they will not have had dedicated airway skills teaching.

This study demonstrates a lack of competence in the management of the airway by junior doctors who are often first on the scene. We suggest, at induction, all junior doctors should undergo a basic airway management course.

Young, S; Bolton, NJW; Sim, KJ. (2013).  Delivery of effective ventilation during cardiac arrest . Intensive Care Medicine. 39 (Issue 2 Supple), S477

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