Content provided by Intersurgical Inc.
Out-of-hospital cardiac arrest (OHCA) remains one of the toughest calls in EMS. Providers know what the science recommends — minimize interruptions, manage the airway early, ventilate within guardrails — but field realities often derail execution. Airway attempts get delayed, gastric decompression gets skipped and hyperventilation sneaks in during the chaos of the scene.
Improving outcomes starts with tightening fundamentals and standardizing how crews approach airway and ventilation. Here are five ways to improve consistency, protect perfusion and move the needle on survival.
1. Make first-pass success the expectation
Every airway attempt interrupts compressions and risks losing perfusion. The priority isn’t which device wins the debate — it’s achieving effective ventilation on the first try.
Tip: Build training and QA around first-pass success as a performance metric. Review data on how often crews achieve it, identify factors contributing to delays and address them through practice scenarios. Studies like AIRWAYS-2 found supraglottic airways were faster and more reliable to place than endotracheal tubes in some systems,with similar survival rates. Emphasize preparation, clear role assignments and early decision-making so the first attempt is deliberate and efficient.
2. Build decompression into your resuscitation sequence
Gastric distention raises intrathoracic pressure and reduces venous return, which can decrease the chance of ROSC. Yet, decompression is often skipped in the rush of resuscitation. EMS systems that make NG/OG placement a standard step — not an optional one — report higher rates of sustained pulses.
Tip: Incorporate decompression into your cardiac arrest checklist. Assign it early, right after airway confirmation. If you use SGAs with built-in gastric channels, train crews to pass a tube and aspirate immediately before shifting attention elsewhere.
3. Guard against over-ventilation
Hyperventilation remains one of the most frequent and preventable causes of resuscitation failure. Over-bagging raises thoracic pressure, lowers coronary perfusion and pushes patients outside physiologic limits.
In the 2025 American Heart Association Guidelines for CPR and ECC, the AHA notes a tidal volume of 362-406 mL (approximately 5–7 mL/kg for the average adult) is necessary to achieve chest rise.
Tip: Pair training with tools. Use feedback devices or bag-valve-masks designed to limit volume and rate. Even simple interventionscan reinforce proper timing under stress.
4. Standardize your approach
Agencies often train and purchase airway, decompression and ventilation tools separately. That fragmentation leads to gaps when stress levels rise. A standardized sequence reduces variability and helps every provider follow the same playbook.
Tip: Bundle training around real arrest flow: secure airway, decompress, ventilate, reassess. Use manikin scenarios to practice the handoffs between these steps. Treat the sequence as one integrated skill, not three separate ones.
5. Measure what’s actually happening in the field
Improvement starts with visibility. Too few agencies routinely track metrics like first-pass success, decompression rates or ventilation compliance. Data from cardiac arrest reviews and monitor downloads can identify where process drift occurs — and where simple reinforcement could improve consistency.
Tip: Add two quick checks to your post-event review: Was a gastric tube placed? Were ventilations within target rate and volume? Building these into QA conversations keeps airway and ventilation performance front of mind.
Bringing it all together
When airway control, decompression and ventilation are reliable and repeatable, everything else in cardiac arrest care performs better. Crews can focus on compressions and rhythm management instead of juggling details.
While somemanufacturers are developing tools and frameworks that make this integration easier, the principle is clear: make the right actions simple and automatic, even under stress.
The more consistent airway and ventilation become, the closer EMS gets to closing the gap between science and survival — and turning best practices into better outcomes.