Review of Respiratory Arrest

Respiratory Arrest simply means cessation of breathing. In ACLS, respiratory arrest

typically means that a patients respirations are completely absent or inadequate to
maintain oxygenation, but a pulse is present.
Management of respiratory arrest includes the following interventions:
Give oxygen
Open the airway
Provide basic ventilation
Provide respiratory support with the use of artificial airways (OPA and NPA)
Suction to maintain a clear airway
Maintain airway with advanced airways
During respiratory arrest, the ACLS provider should avoid hyperventilation of the patient.
Hyperventilation is providing too many breaths per minute or too large of a volume per
breath during ventilation. Hyperventilation may lead to increased intrathoracic pressure,
decreased venous return to the heart, diminished cardiac output, and increased gastric
inflation, all of which can decrease the likelihood of positive outcomes.

For patients with a perfusing rhythm deliver 1 breath every 5 to 6 seconds.

Opening Airway
The most common cause of airway obstruction in a patient that is unresponsive is the
loss of tone in the throat muscles. When loss of throat muscle tone occurs the tongue
can fall back and obstruct the airway.
This type of obstruction is easily prevented with a basic airway opening technique called
the head tilt-chin lift. In the case that spinal injury is suspected, the jaw thrust maneuver
can be utilized. This jaw thrust maneuver allows the BLS/ACLS provider to maintain a
stable cervical spine.

ACLS Ventilation
There are 5 basic airway skills used to ventilate a patient. Basic ventilation skills are
discussed in the BLS course and will not be discussed in detail here. The following is a
list of the 5 basic airway skills: 1.) Head tilt-chin lift; 2.) Jaw thrust without head extension
for possible cervical spine injury; 3.) Mouth-to-Mouth ventilation; 4.) Mouth-to-Barrier
device (using a pocket mask); and 5.) Bag-mask ventilation.
Bag-Mask ventilation
Bag-Mask ventilation is the most common method of providing positive-pressure
ventilation. Both the oropharyngeal airway and the nasopharyngeal airway may be used
as adjuncts to improve effectiveness of patient ventilation. The oropharyngeal airway
may only be used on the unconscious patient because it can stimulate gagging and
vomiting in a conscious patient. The nasopharyngeal airway may be used on the
unconscious patient or on the semiconscious patient and is also indicated if a patient
has massive trauma around the mouth or wiring of the jaws.
Suctioning
If the airway is being maintained with the basic airway skills listed above, blood,
secretions, and vomit become the primary causes of an obstructed airway in the
unconscious patient. Suctioning should be used to clear the airway if it becomes
occluded with these body fluids.

Limit oral and endotracheal suctioning to 10 seconds or less to reduce the risks of
hypoxemia. Monitor for changes in heart rate as oropharyngeal suctioning can cause
vagal stimulation resulting in bradycardia.

Advanced Airways
Advanced Airways used during ACLS include Combitube, LMA (Laryngeal mask airway),
and ET tube (endotracheal tube). Once an advanced airway is in place, chest
compressions are no longer interrupted for ventilations. 1 breath should be given every
6-8 seconds (8-10 breaths per minute).
You should be given adequate time to practice with these devices during your ACLS
training before ACLS megacode testing.