Date Published

September 22, 2020

Updated For

ALS PCS Version ALS PCS Version 5.2


Is external manual compression of the chest and appropriate prehospital consideration for peri-arrested or arrested asthma exacerbated patients who are showing obvious signs of chest hyperinflation and air trapping. I have read about its anecdotal use on website like and in the Prehospital Care Journal (Harrison, R. Chest compression first aid for respiratory arrest due to acute asphyxic asthma. Emerg Med J 2010;27:59€“61. doi:10.1136/emj.2007.056119) as a few sources. I have also seen it performed in the emergency department by emergency physicians. I assume with good technique, it can assist with expiration and minimize the risk of barotrauma in these patients who require ventilation. Thank you!


Per the Respiratory Failure Standard in the BLS-PCS: In situations involving a patient in respiratory failure, the paramedic shall: 1. ventilate the patient as per current Heart and Stroke Foundation of Canada Guidelines.  The use of manual decompression is mentioned in the AHA/ECC Guidelines Part 10: Special Circumstances, in the setting of troubleshooting after intubation.

Due to the auto-PEEP pathophysiology of the bronchoconstriction, full manual exhalation can be difficult to achieve, leading to hyperinflation, hypotension and/or tension pneumothorax.  In order to minimize this phenomenon the guidelines suggest: decreasing the respiratory rate, minute volume and expiratory rate (1:4, inspiration:expiration duration).  The guidelines mention that this is not enough that disconnecting the patient from the ventilator and attempting manual chest decompression is an option.

Should you run into a situation in which you are providing manual respirations for a severe asthmatic patient and you feel that their lungs are hyper-inflated due to auto-PEEP and not allowing any air in with your respirations: Pause, slow down your respiratory rate and minimize your manual respiration volume (~6mL/kg).  If this is not enough, you could consider patching to a BHP for direction on manual chest decompression, as this is outside of your typical scope of practice.

Javonas EJ et al.  Part 10: Special Circumstances of Resuscitation.  2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscittion and Emergency Cardiovascular Care.  Circulation.  2015.



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