Advancements in Airway Management and Ventilation in a Prehospital Cardiac Arrest: A Narrative Review

Abstract

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death worldwide, with survival rates heavily dependent on the quality of prehospital advanced life support (ALS). Among the critical components of ALS, optimal airway management and ventilation strategies are essential to ensuring adequate oxygenation and facilitating effective resuscitation. This narrative review examines the evolution and current best practices in airway management and ventilation during prehospital resuscitation for OHCA. A comprehensive overview of traditional and emerging techniques, including bag-valve mask (BVM) ventilation, supraglottic airway devices (SADs), and endotracheal intubation, is provided, with a particular focus on their respective advantages and limitations in prehospital settings. Additionally, the role of mechanical chest compression devices, ventilator use, and feedback mechanisms in improving the quality of resuscitation are explored. The review also addresses the critical role of training, experience, and team dynamics, emphasizing the importance of specialized care teams, including prehospital physicians and anesthesiologists, in optimizing outcomes. Despite ongoing challenges and variations in clinical practice, the evidence suggests that a systematic approach, informed by up-to-date guidelines, feedback, and continuous professional development, is vital for improving patient survival rates in OHCA. By integrating advanced airway management techniques with optimized ventilation strategies, prehospital care providers can significantly enhance the efficacy of resuscitation efforts, ultimately improving the chances of survival and neurological recovery for OHCA patients.