Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest

Publication Date: November 14, 2019
Last Updated: March 14, 2022

Updated Recommendations

Either BMV or an advanced airway strategy may be considered during CPR for adult cardiac arrest in any setting.
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If an advanced airway is used, the SGA can be used for adults with OHCA in settings with low tracheal intubation success rate or minimal training opportunities for ETT placement.
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If an advanced airway is used, either the SGA or ETT can be used for adults with OHCA in settings with high tracheal intubation success rates or optimal training opportunities for ETT placement.
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If an advanced airway is used in the in-hospital setting by expert providers trained in these procedures, either the SGA or ETT can be used.
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Frequent experience or frequent retraining is recommended for providers who perform ETI.
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Emergency medical services systems that perform prehospital intubation should provide a program of ongoing quality improvement to minimize complications and to track overall SGA and ETT placement success rates.
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We recommend that epinephrine be administered to patients in cardiac arrest.
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On the basis of the protocol used in clinical trials, it is reasonable to administer 1 mg every 3 to 5 minutes.

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High-dose epinephrine is not recommended for routine use in cardiac arrest.
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Vasopressin may be considered in a cardiac arrest but offers no advantage as a substitute for epinephrine in cardiac arrest.
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Vasopressin in combination with epinephrine may be considered during cardiac arrest but offers no advantage as a substitute for epinephrine alone.
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With respect to timing, for cardiac arrest with a nonshockable rhythm, it is reasonable to administer epinephrine as soon as feasible.
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With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to administer epinephrine after initial defibrillation attempts have failed.
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There is insufficient evidence to recommend the routine use of ECPR for patients with cardiac arrest.
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ECPR may be considered for selected patients as rescue therapy when conventional CPR efforts are failing in settings in which it can be expeditiously implemented and supported by skilled providers.
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BMV, bag-mask ventilation; CPR, Cardiopulmonary Resuscitation; ECPR, extracorporeal CPR, ETI, endotracheal intubation; ETT, endotracheal tube; IHCA, in-hospital cardiac arrest; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation; SGA, supraglottic airwa

Recommendation Grading

Overview

Title

Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest

Authoring Organization

American Heart Association

Publication Month/Year

November 14, 2019

Last Updated Month/Year

January 31, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This 2019 focused update to the American Heart Association advanced cardiovascular life support guidelines summarizes the most recent published evidence for and recommendations on the use of advanced airways, vasopressors, and extracorporeal cardiopulmonary resuscitation during cardiac arrest. 

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Emergency care, Hospital, Medical transportation

Intended Users

Nurse, nurse practitioner, paramedic emt, physician, physician assistant

Scope

Treatment

Diseases/Conditions (MeSH)

D016757 - Death, Sudden, Cardiac

Keywords

sudden cardiac arrest, sudden cardiac death, mechanical circulatory support, cardiac arrest

Source Citation

2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Ashish R. Panchal, MD, PhD, Chair, Katherine M. Berg, MD, Karen G. Hirsch, MD, Peter J. Kudenchuk, MD, FAHA, Marina Del Rios, MD, MSc, José G. Cabañas, MD, MPH, Mark S. Link, MD, FAHA, Michael C. Kurz, MD, MS, FAHA, Paul S. Chan, MD, MSc, Peter T. Morley, MBBS, FAHA, Mary Fran Hazinski, RN, MSN, FAHA, Michael W. Donnino, MD