6.2 BLS Ventilation When an Advanced Airway Is Present

6.2 BLS Ventilation When an Advanced Airway Is Present

An advanced airway changes the coordination of compressions and breaths during cardiac arrest. It does not change the need for high-quality CPR, visible chest rise, minimal interruptions, or careful ventilation timing.

The key transition

Before an advanced airway is present, rescuers pause compressions briefly to provide 2 breaths in a 30:2 or 15:2 cycle. After the airway is placed and the team responsible for it confirms that ventilation can proceed:

• The compressor gives continuous compressions at 100-120/min.
• The ventilation rescuer gives breaths independently.
• Compressions do not pause for each breath.

This is often called asynchronous ventilation because breaths and compressions occur on separate schedules.

Ventilation intervals by age

Deliver each breath over about 1 second using only enough volume for visible chest rise. Count the interval aloud or use a timer when helpful. Do not speed up simply because compressions are continuous.

BLS team responsibilities

Airway placement and confirmation are performed by providers trained and authorized for the device. The BLS rescuer can contribute by:

• Continuing compressions during the placement attempt whenever possible.
• Handing equipment without abandoning an assigned critical role.
• Stabilizing tubing or the ventilation connection as directed.
• Watching for chest rise with each breath.
• Reporting a new leak, disconnection, absent chest rise, vomiting, or a change in airway position.
• Tracking the age-appropriate breath interval.

Do not stop compressions for a prolonged airway attempt. Basic bag-mask ventilation with effective chest rise and uninterrupted CPR is preferable to sacrificing core BLS quality for an advanced procedure.

Avoid excessive ventilation

Excessive ventilation may result from an incorrect rate, too much volume, or a rapid forceful squeeze. It can increase pressure in the chest and inflate the stomach. Prevent it by using the prescribed interval, a 1-second breath, and visible chest rise as the endpoint.

Continuous compressions can make the chest move, so the ventilation rescuer should distinguish compression movement from the rise produced by a breath. Coordinate observation with the airway holder and use feedback available to the trained team.

If chest rise is lost

Communicate immediately: “No chest rise.” Then, without creating an unnecessary compression pause:

1. Confirm the bag is connected and functioning.
2. Check for a kink, disconnection, or displaced tubing.
3. Reassess mask or airway equipment according to role and training.
4. Follow the advanced provider's plan for device confirmation or replacement.
5. Return to effective bag-mask ventilation if the advanced airway is no longer usable and the team directs removal.

An advanced airway is not an absolute guarantee against displacement, leak, obstruction, or aspiration. Ongoing observation remains necessary.

Pulse present but breathing inadequate

The age-specific rescue-breathing rates are the same when an advanced airway is used for a patient who has a pulse:

• Adult: 1 breath every 6 seconds.
• Infant or child: 1 breath every 2-3 seconds.

Reassess pulse and breathing about every 2 minutes. If the pulse is lost, begin or resume the cardiac-arrest compression pattern.

Common errors

• Continuing 30:2 or 15:2 pauses after an advanced airway is established.
• Giving every age group 1 breath every 6 seconds.
• Hyperventilating because compressions no longer provide a counting cue.
• Assuming the airway can never dislodge.
• Stopping CPR for a lengthy placement attempt.
• Confusing an advanced airway with a reason to reduce compression rate or depth.

On the exam, identify both the patient's age and whether an advanced airway is present. With the airway in place during arrest, compressions are continuous and breaths follow the age-specific timer.

Timing practice

The easiest way to prevent hyperventilation is to rehearse the actual intervals. With a metronome running at the compression rate, have one rescuer compress continuously while another gives adult breaths every 6 seconds. Repeat with pediatric breaths every 2-3 seconds. The compressor should not hesitate when a breath arrives. The airway rescuer should watch for rise, allow exhalation, and resist using the faster pediatric interval for an adult or the slower adult interval for a child.

Switch roles so both rescuers can maintain the correct independent timing.

Practice both timing patterns until each remains stable without prompting.