The Oropharyngeal and Nasopharyngeal Airway Combined with CPR - What's Missing in Professional Training?

Recently there has been televised promotion of what's known as "hands only" cardiopulmonary resuscitation (CPR) to be performed by laypeople who could be instrumental in saving a life while waiting on the arrival of emergency medical technicians (EMTs) and paramedics. If a person is in respiratory arrest, it's somewhat difficult to imagine not providing rescue breathing for him also, but hands only CPR is better than nothing in cases of cardiac arrest. Layman CPR training is different from the training that professional health care providers receive. The professional rescuer learns how to perform rescue breathing and CPR on infants, children, and adults; we also learn how and when to use an automated external defibrillator (AED). I was trained by the Red Cross in CPR for the professional rescuer to meet one of the many requirements for my EMT training. Although the training was very good, I have some complaints and suggestions for other trainees. This is just my opinion, but I believe that professional rescuer training in CPR should also cover the use of the oropharyngeal airway and the nasopharyngeal airway; these are known as airway adjuncts.

The day on which I gathered with about 300 other students to take the practical exam for EMTs, I found out that the cardiac station was the one of the three stations we had to pass that gave students the most trouble. In fact, it was the station that was most often failed. I passed with no problems, partly because my CPR training was more recent that most of the other students, and because the areas of respiratory and cardiac arrest were probably the ones in which I had asked the most questions. If we had been trained how to incorporate the use of the oropharyngeal airway and a nasopharyngeal airway, I wouldn't have had so many questions. The Red Cross concentrated on CPR, rescue breathing, use of an AED, and basic first aid. My EMT training covered airway adjuncts, but as a separate study that wasn't combined with CPR training. Perhaps this is no big deal for some students, but I believe that the failure rate in the cardiac station says otherwise.

Achieving a Smooth Combination of Rescue Breathing, CPR, and Airway Adjunct Use for the Professional Rescuer

If you are an EMT student, you should be well aware of what an oropharyngeal airway is and what a nasopharyngeal airway is. You should also know when their use is contraindicated. The focus of this article is not on what these things are, but on learning how to incorporate them into rescue breathing, often performed during CPR. Let's say that you have an apneic (non-breathing) patient for whom you need to begin rescue breathing and will be using an oropharyngeal airway for example. If there's no suspicion of a spinal cord injury, no gag reflex or contraindications, after you've performed the head-tilt-chin-lift maneuver, you can actually go ahead and insert the oropharyngeal adjunct even before giving the first two rescue breaths.

When you go for your practical exam at which you'll have to pass the cardiac station, you'll need to communicate everything you're doing for your patient to the examiner. For example, during my test in the cardiac station, I didn't have an adjunct in when I gave the first two rescue breaths, but I made sure I upgraded to one immediately after completing the first 30 chest compressions (I was the only rescuer) and explained to the examiner what I was doing. After completing the second round of 30 compressions, I removed the adjunct and upgraded to the Combitube; but, had there not been one available (a Combitube), I would have left the adjunct in place until and unless the examiner said that the patient was regaining consciousness. Take the time to examine your equipment before you tell the reviewer that you are ready to begin. You not only want full understanding of how to manage respiratory and cardiac emergencies when going before state examiners, but also when the time comes that your practice on a dummy is over and you must render care to a real patient.
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Source:

My EMT training and experience (NREMT certification and state licensed)