Performing CPR to adults with an advanced airway

Individuals who sustained injuries or illnesses to the airway have an advanced airway (stoma) device implanted in the trachea. This would require performing mask-to-stoma CPR but it has minor modifications that you have to be familiar with. It is best to acquire an advanced CPR certification due to these modifications.

Assess the emergency scenario

  • Check first if it is safe to approach the individual.
  • Check if the individual is conscious by tapping or calling his/her name.
  • In case the individual is unresponsive, roll him/her gently on his/her back.
  • The airway must be in neutral position (the head is level with the chin at 90 degrees).
  • Check for breathing and any signs of life by positioning your ear above the stoma. You have to listen and feel for breathing while looking down at the body if the chest rises for no more than 10 seconds.
  • Check for a pulse if the victim is an infant. If the individual is not breathing, call for emergency assistance.

Performing CPR

advanced airway

Insert a one-way valve into the resuscitation mask.

  • Insert a one-way valve into the resuscitation mask.
  • Create a seal over the stoma with the mask while holding both the nose and mouth closed.
  • Position your mouth over the mouthpiece and deliver two rescue breaths for a second duration. Provide a blow just enough to make the chest rise visibly. If the breaths do not go in, you have to adjust the airway and the seal of the mask and deliver two more rescue breaths.
  • The hands must be in compression position – heel of lower hand on the middle of the breastbone while second hand on top with finger interlocked. Directly lean over the individual, strengthen your arms and press straight down at the rate of 100 bpm. For adults, deliver 30 compressions at a depth of 1 ½ to 2 inches. As for children, deliver 15 compressions at a depth of 1 – ½ inches. For infants, compress using 2 or 3 fingers for 15 times at the depth of ½ – 1 inch.
  • Deliver 2 breaths and then continue with 15 or 30 compressions. Take note that every combination of 2 breaths and 15 or 30 compressions is considered as a cycle. Continue the CPR cycles until the medical team arrives.

Important considerations to bear in mind

Once you decide to enroll in a first aid course, you have to inform the instructor that you need the advanced airway CPR lesson. In this course, you will learn and practice how to use an infant resuscitation mask. The part of the procedure where you hold the nose and mouth close with one hand while creating a seal with the mask would require practice on a manikin.

It is important to have a resuscitation mask on hand all the time. Do not abandon the individual just to look for a mask or barrier. If this is the case, you have to perform rescue breathing using the mouth-to-stoma technique. The moment it is started, do not discontinue the CPR except if you are too tired to carry on or once the scene become unsafe.


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