Should we intubate patients during cardiopulmonary resuscitation?

As a trainee anaesthetist in the early 1980s, attendance at a “cardiac arrest” was frequent. My role was to intubate and ventilate the patient’s lungs with the highest possible concentration of oxygen. Other members of the team would insert a central line; attach an electrocardiogram monitor; give calcium, sodium bicarbonate, and intra-cardiac adrenaline; and defibrillate the patient, often in this sequence. Little attention was paid to chest compressions, a task usually delegated to the most junior person, often a student.

Over the years, most of these interventions have been abandoned as research has clarified which ones are associated with improved outcomes—namely good quality chest compressions and early defibrillation when the rhythm is ventricular fibrillation or ventricular tachycardia. So why are we still intubating patients’ tracheas as part of their management during cardiopulmonary resuscitation?

Perhaps the strongest reasons are the well known benefits of intubation during general anaesthesia—including effective ventilation in patients with poor pulmonary …