Pausing for the tube

[Melclin]

I've been thinking lately about the time spent pausing compressions for intubation during cardiac arrest causing a bit of a hullabaloo and I remembered FLEMTP saying mentioning not pausing at all.

So.. I can't think of a way to break down a poll properly so if we could just post... How many of you do not pause compressions for intubation and if you do, how long and why exactly (other than, because mosby's EMT-P said so)?


(I know other threads have touched on this issue, but I couldn't find one that gave me the numbers to answer my questions)

 

[sir.shocksalot]

I never pause compressions for a tube, the one time I did, it didn't make much of a difference for me. I have seen docs do it, but its for no more than 30 seconds or so. Studies have pretty well shown that time off the chest is bad for patient survival rates, and field arrests tend to have more time off the chest than there should be (in my experience).

 

[MrBrown]

Most here just whip out an LMA, shove it down the patients gob and blow up the cuff.

I have only seen one cardiac arrest intubated and that was post ROSC when he was still unconscious with a GCS of 3.

 

[emt/ff71185]

I never pause for a tube. I have also seen doctors pause in the ER setting but I do not feel it is worth the pause. Take a quick look with compressions in progress and if you don't see anything than pull out and insert appropriate blind airway device.

 

[bstone]

If you have veinous access established, then don't use the tube. LMA, King, etc. Less down time, better outcomes.

 

[MasterIntubator]

If the airway is patent and compliant, we just do the meat of the stuff. When its desert time, I tube without stopping compressions. Once the equipment is ready... about 5 seconds is all that is needed to pass the tube.

 

[Lifeguards For Life]

Don't pause.

 

[task]

Just need to pause for a second to check for breath / epigastric sounds after the tube is placed.

Cric pressure helps when tubing a pt with CPR in progress.

 

[Veneficus]

I've been thinking lately about the time spent pausing compressions for intubation during cardiac arrest causing a bit of a hullabaloo and I remembered FLEMTP saying mentioning not pausing at all.

So.. I can't think of a way to break down a poll properly so if we could just post... How many of you do not pause compressions for intubation and if you do, how long and why exactly (other than, because mosby's EMT-P said so)?


(I know other threads have touched on this issue, but I couldn't find one that gave me the numbers to answer my questions)

I do not pause for compressions to intubate. But I do hold my breath and when it is time for me to breath it is time for the patient to breathe.

 

[alphatrauma]

Just need to pause for a second to check for breath / epigastric sounds after the tube is placed.

capnography?

 

[BLSBoy]

I don't pause. I also load my tubes with a gum bougie, so its MUCH easier to pull the tube up a bit, put the bougie in, and slide the tube down.

 

[alphatrauma]

I do not pause for compressions to intubate. But I do hold my breath and when it is time for me to breath it is time for the patient to breathe.

I like this!

 

[CCNRMedic1982]

I do not pause for compressions to intubate. But I do hold my breath and when it is time for me to breath it is time for the patient to breathe.

I have heard of quite a few people doing this and it doesn't really make alot of sense to me......I can barely hold my breath for 30 seconds, my wife used to be a swimmer and she can hold her breath forever( or so it seems, really for a few minutes w/o feeling short of breath). So how do you know how long goes by that your not ventilating your patient? I don't stop CPR for Intubation if it appears that it is going to be a difficult airway then Intubation isn't even attempted and a BIAD is inserted. Minimizing interruptions in CPR is very vital to pt. outcome, The same should be said for providing adequate ventilations and oxygenation to the pt. I think sometimes this is forgotten during an arrest so that someone can do a cool skill....

 

[Veneficus]

I have heard of quite a few people doing this and it doesn't really make alot of sense to me......I can barely hold my breath for 30 seconds, my wife used to be a swimmer and she can hold her breath forever( or so it seems, really for a few minutes w/o feeling short of breath). So how do you know how long goes by that your not ventilating your patient? I don't stop CPR for Intubation if it appears that it is going to be a difficult airway then Intubation isn't even attempted and a BIAD is inserted. Minimizing interruptions in CPR is very vital to pt. outcome, The same should be said for providing adequate ventilations and oxygenation to the pt. I think sometimes this is forgotten during an arrest so that someone can do a cool skill....

Intubation is not a cool skill. Surgical cric is a cool skill, but I don't look for reasons to do it.

As for the breath thing. The simple answer for me is I think I am fairly average in the ability to willfully control my respiratory drive. It certainly isn't 2 minutes worth of ability. Usually I have to stop and vent before even the ETCO2 falls to 35mmhg. (in which case the machine starts alarming and that is always the cue to ventilate)

An anesthesia friend of mine likes to say (and I buy into 100%) people don't die from not having a plastic tube in their face. They die from tissues not properly being perfused.

As I am sure you are aware, an ET tube may be the gold standard of controlling an airway, it certainly doesn't solve all of the issues associated with ventilation or oxygenation.

Inserting a tube isn't automatically the focus of my attention in a code. (though sometimes circumstances call for it to be)

 

[WolfmanHarris]

capnography?

Shouldn't rely on just capnography for verification. Protocol not withstanding (we're required to verify and document x2) when I insert a king I auscultate epigastric and lungs, watch rise and fall and misting of the tube and attach the ETCO2 filterline.

 

[Melclin]

Very Interesting

Wow so..its very common. I wouldn't speak to the whole system here, but in my two arrests that got tubed, the Intensive Care paramedic paused both times, once for almost a minute (which is obviously unacceptable). Talking to a few paramedics around uni, the norm seems to be to pause. Disappointing, but maybe I've got the wrong end of the stick.

To the people who do not pause: is it common in your system not to pause, or are you leading the way?

 

[medic farva]

I don't even attempt to tube my cardiac arrests any more. Insert the king and move on. Don't stop compressions for this. It's about VENTILATION, not intubation. While it may not take too long once your equipment is readied, it takes longer to ready your intubation equipment than it does to slam a king and inflate the cuff and start ventilating.

 

[CCNRMedic1982]

Intubation is not a cool skill. Surgical cric is a cool skill, but I don't look for reasons to do it.

I like that response, thanks.

Surg. Cric is a cool skill, I just did one on a trauma pt. maybe like two weeks ago. But besides the point. Thanks for the reply and like I said just never made alot of sense to me but I do see where your coming from.

 

[Aidey]

Usually I have to stop and vent before even the ETCO2 falls to 35mmhg. (in which case the machine starts alarming and that is always the cue to ventilate)

Huh? Falls to 35mm/hg? That doesn't make any sense to me. I've been taught that in cardiac arrest you want your ETCO2 to be between 45-55mm/hg (with normal living person range being 35-45mm/hg). How low are you getting their CO2 for it to "fall" to 35?

As for the OP, I do everything but actually put the tube in while compressions are going. I look, suction, position the blade, get the cords in view and then right before I put it in I will say stop, and have them resume immediately after it goes through the cords. Pause of 5-10 seconds tops because I don't have to look for the cords, I already can see them.

 

[CCNRMedic1982]

I don't even attempt to tube my cardiac arrests any more. Insert the king and move on. Don't stop compressions for this. It's about VENTILATION, not intubation. While it may not take too long once your equipment is readied, it takes longer to ready your intubation equipment than it does to slam a king and inflate the cuff and start ventilating.

Interesting do you notice an increase in survival rate when you have continuous compressions. I agree with this train of thought and am trying to get my System director and my medical director to buy off on considering this for our cardiac arrest patients. System director is not a fan and thinks that doing this will ultimately take the skill ETI away from the system all together. We have a few medics that do it here just because but alot of the people don't have years on years of experience so when they see something "cool" everything just kind of stops i.e. compressions (which of course is defeating the purpose) but just curious on what kind of results you get from doing this.