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Inserting Breathing Tube May Not Be Best for Victims of Cardiac Arrest
Date:1/15/2013

By Barbara Bronson Gray
HealthDay Reporter

TUESDAY, Jan. 14 (HealthDay News) -- When a person's heart stops beating, most emergency personnel have been taught to first insert a breathing tube through the victim's mouth, but a new Japanese study found that approach may actually lower the chances of survival and lead to worse neurological outcomes.

Health care professionals have long been taught the A-B-C method, focusing first on the airway and breathing and then circulation, through hand compressions on the chest, explained Dr. Donald Yealy, chair of emergency medicine at the University of Pittsburgh and co-author of an editorial accompanying the study.

But it may be more important to first restore circulation and get the blood moving through the body, he said. "We're not saying the airway isn't important, but rather that securing the airway should happen after succeeding in restoring the pulse," he explained.

The study compared cases of cardiac arrest in which a breathing tube was inserted -- considered advanced airway management -- to cases using conventional bag-valve-mask ventilation.

There are a number of reasons why the use of a breathing tube in cardiac arrest may reduce effectiveness and even the odds of survival. "Every time you stop chest compressions, you start at zero building a wave of perfusion [getting the blood to circulate]. You're on a clock, and there are only so many hands in the field," Yealy said.

Study author Dr. Kohei Hasegawa, a clinical instructor in surgery at Harvard Medical School, gave another reason to prioritize chest compressions over airway restoration.

Because many first responders don't get the chance to place breathing tubes more than once or twice a year, he said, "it's difficult to get practice, so the chances you're doing intubation successfully are very small."

Hasegawa also noted that it's especially difficult to insert a breathing
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