When initiating chest compressions, which airway management step is recommended?

• A. Insert an endotracheal tube and increase oxygen to 100% with placement confirmed by chest X-ray, auscultation, CO2 detector, or visualization through the cords
• B. Rely on bag-valve-mask ventilation only during compressions
• C. Place a nasopharyngeal airway and avoid intubation during compressions
• D. Delay airway management until after compressions

Answer: (A)

Securing the airway early with a definitive airway and delivering high‑quality ventilation is essential during chest compressions. The best approach is to insert an endotracheal tube and provide 100% oxygen, confirming placement with waveform capnography (and using auscultation or visualization as supplementary checks). This setup allows continuous chest compressions with minimal interruptions while ensuring reliable ventilation and oxygen delivery to the tissues.

Using a bag‑valve‑mask alone during compressions can introduce more pauses and inconsistent ventilation, making it harder to maintain adequate oxygenation. A nasopharyngeal airway without a secured airway doesn’t protect the airway or guarantee reliable ventilation during CPR. Delaying airway management until after compressions sacrifices ventilation during the critical early phase of resuscitation.