Questions regarding intubation. Should we be opting for aggressive airway management with intubation or SGA on VSA patients as well as severely obtunded non-asthmatic patients where patient presentation would allow? Should this take precedence over ACLS drugs during cardiac arrest? When intubated with inline filter in place are we permitted to BVM an normal rate?
We can answer the easy question first €“ yes, an in-line filter (ex. hydrophobic submicron filter, HME filter) should be utilized in all patients that are receiving manual ventilation. Please see the Ask MAC from (date and link to question about filters that we previously posted). Ventilation should occur at a normal rate.
Unfortunately there is very little evidence to guide airway strategies with COVID-19 and much of it will be expert opinion. At this time, there is probably no right or wrong answer and there are pros and cons to different approaches. The OBHG MAC is currently in the process of developing airway guidelines both for cardiac arrest and respiratory distress patients. It is hoped that these will be released soon in the OBHG Memo #3. At this time, in patients with cardiac arrest, high quality CPR and early defibrillation should remain priorities with airway management as soon as feasible. Given the changing landscape and ongoing discussion, this direction may change soon and SWORBHP will communicate any changes as they are made.