“… with a slight breath the lung will swell and the heart becomes strong … and as I do this and take care that the lung is inflated at intervals, the motion of the heart does not stop …”
Maintaining a patent airway is of paramount importance if the lungs are to be inflated successfully with high inspired oxygen concentration during cardiopulmonary resuscitation (CPR) attempts. The association between delivering adequate breaths via a patent airway and maintenance of cardiac function was clearly recognized by Vesalius in the sixteenth century. Patients requiring CPR often have an obstructed airway, usually caused by loss of consciousness, but occasionally it may be the primary cause of cardiopulmonary arrest. Prompt assessment, with control of the airway and ventilation of the lungs is essential. This will help to prevent secondary hypoxic damage to the brain and other vital organs as well as maintaining cardiac function. Without adequate oxygenation it may be impossible to restore a spontaneous cardiac output from a myocardium in cardiac arrest.
An extensive review of the science behind airway management during cardiac arrest was published recently: the 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR). The European Resuscitation Council (ERC) Basic Life Support (BLS) and Advanced Life Support (ALS) Working Parties have recently published new guidelines on management of the airway during cardiac arrest and these were based partly on the recommendations published in CoSTR.