In ABCs, Airway should be last!

Back in May of 2008, the American Heart Association changed the CPR and resuscitation protocols. You no longer have to do mouth-to-mouth CPR and if it is an in-hospital arrest, you don’t have to intubate right away.

They have done research and have found that doing proper chest compressions, in and of itself, provides plenty of air exchange. The air exchange is not the problem, the problem is circulation. They need blood to circulate the oxygen, so you have to do compressions.

They also found that if you keep telling people to do mouth to mouth, they are less likely to help out. They just walk away quickly. That doesn’t help anyone.

If you find someone down and without a pulse, start chest compressions. It’s that simple! Nothing saves lives or prolongs lives more than chest compressions. Deep, fast chest compressions. 100 per minute. When a chest is compressed and allowed to recoil, that draws plenty of air and oxygen into the lungs. Further, stopping chest compressions to breathe into their mouths, is an interruption of blood flow to the brain. The brain does not tolerate those kinds of interruptions very well. You need circulation!

In normal humans, (who are alive and walking around) tissues and organs extract only 25% of total oxygen from blood. When someone isn’t breathing, tissues and organs can extract more oxygen. Doing chest compressions, provides more than enough air and oxygen for tissues and organs to work with.

Being someone that lives in the hospital, I see it all the time. Whenever there is a cardiac arrest, everyone jumps up and down and gets excited about “airway”. Everyone wants to be a hero and be the one to intubate. In reality, you can wait. Intubation is the last step. If they don’t have a pulse, start compressions. You can always just “bag” the patient with the mask until later when you figure out what is going on. And that is what the American Heart Association recommends. Wait on airway!

Airways are not benign. Lots of bad things can happen when you are trying to get an airway. Just bag them until things are more stable.

Unfortunately, old habits are hard to break. Physicians and other health professionals are always taught the “ABCs” of cardiac arrest:


I am not sure why airway and breathing are before circulation. Circulation should come first! They should just throw out A and B. Or put them waaaaaaaaaaay last! It should be C…… AB or C……. BA. But I guess it’s easier to remember if you just teach everyone “ABC”. Doctors are supposed to be smart and not need to rely on such sophomoric mnemonics to help them practice good care.

Next time you run to a code blue, you can sound smart by stating that, “We can wait on airway, that was taken out of the guidelines two years ago.”

Wait till the patient has been stabilized, or you know what is really going. You can hold off on airway until you get to the ICU or a more controlled environment and wait until you know that nothing else will suffice and you have to have an airway. If you are in the mall, just do chest compressions until the paramedics arrive. You will have saved a life!