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Airway Management Changes in the 2010-2015 ACLS Guidelines

This page summarizes the most recent and significant changes in airway management practices, as based on the evidence available in 2010.

1. The most significant change is possibly the recommendation for routine use of quantitative waveform capnography (QWC) for use in confirmation and monitoring the correct placement of an endotracheal tube. Evidence has shown that his is the most reliable and correct method of confirmation and continuing monitoring of the correct of an ET tube. In the past, colorimetric devices have been utilized, but the evidence is clear that colorimetric ETCO2 devices should only be used when waveform capnography is unavailable.

2. Use of Supraglottic advanced airways, which include laryngeal mask airways (LMA)< esophageal-tracheal tubes (combitube), and laryngeal tubes continue to be used as an alternative to endotracheal intubation for airway management during CPR or cardiopulmonary arrest.

These devices are equally as effective as either bag-valve mask or endotracheal tube for delivery of ventilation when utilized by trained personnel.

3. Cricoid pressure is no longer utilized routinely during airway management of patients in cardiac arrest, and is no longer recommended. This is due to reduced effectiveness of ventilations and interference with placement of an endotracheal tube or a supraglottic airway.