Tracheostomy Access During Cardiac Arrest

Question about ventilation during cardiac arrest for a pt that has a current tracheotomy. When ventilating what compression to ventilation rate is appropriate? Are we treating that tracheotomy like an advanced airway and doing asynchronous breaths and compressions? Or are we doing 30:2?

Thank you for your question! A patent tracheostomy tube is classified and managed as an advanced airway during resuscitation due to its direct and isolated access to the lower respiratory tract. Unlike non-invasive methods (such as standard bag-valve-mask ventilation over the face), a tracheostomy tube bypasses the upper airway entirely, sitting directly within the trachea to provide a secure conduit to the lungs. Consequently, it circumvents common upper airway obstructions, including tongue displacement, laryngospasm, pharyngeal edema, and facial trauma. Furthermore, the outer cannula terminates in a standard 15 mm connector, rendering it functionally identical to an endotracheal tube or supraglottic airway for attaching resuscitation equipment. Resuscitation Strategy: Multi-Rescuer CPR: Deliver asynchronous ventilations at a rate of 1 breath every 6 seconds (10 breaths/min) alongside continuous, uninterrupted chest compressions (100–120/min). Single-Rescuer CPR: Perform standard 30:2 compressions-to-ventilations to prevent excessive pauses in chest compressions during solo resuscitation. Air Leak Management: Tracheostomy tubes may be cuffed or uncuffed. When ventilating through an uncuffed tube, or one with a deflated or damaged cuff, delivered air may escape through the upper airway, reducing ventilation effectiveness. Paramedics should assess for adequate chest rise and monitor available ventilation parameters. If a significant air leak is present, manually occluding the mouth and nose or applying a tight-fitting face mask over the upper airway may improve ventilation. The priority remains effective oxygenation and ventilation while minimizing interruptions in chest compressions.