Introduction

The history of CPR is in part documented in the Old Testament, but the science of CPR is but a half century old and is still emerging from its infancy. Accordingly, it is not unexpected and certainly not shameful that as the science of resuscitation goes forward, we must sometimes retreat as often as we advance. Yet, that is indeed progress and inevitably the path that is characteristic of meaningful achievements in science and medicine.

Airway techniques and devices

One size does not fit all

The vast majority of sudden deaths in children and, indeed, in victims under the age of 40 years are attributable to failure of ventilation. Accordingly, either mechanical obstruction by foreign body, laryngospasm, or laryngeal edema, or bronchoconstriction, constrains air exchange. Neuromuscular or skeletal injury, including intrathoracic crises such as pneumothorax, may account for death, though typically not sudden death. It is in these settings that the priority is establishment and maintenance of a patent airway and external ventilation. Since a majority of the foreign bodies that are swallowed by children and adults lodge in the posterior pharynx, the rescuer is the person best prepared to remove these promptly. Hence, the traditional (A) of the ABC survives, especially for children and young adults and in settings of witnessed cardiac arrest when respiratory distress with paradoxical chest and abdominal movements and especially stridor precedes loss of consciousness.

There has been an appropriate re-examination of the role of routine endotracheal intubation during CPR, whether in the field or in the hospital.