Most cases of cardiac arrest in children are the result of respiratory deterioration, which is why airway and ventilation management are critical components of pediatric advanced life support (PALS). The majority of children can be sufficiently ventilated and resuscitated with bag-mask ventilation. However, this method is limited by the interruption of chest compressions, risk of barotrauma, and risk of aspiration. And although endotracheal intubation establishes a more definitive airway, it requires a high level of skill and specialized equipment. Providers who do not routinely perform this procedure in pediatric patients may find it difficult, a risk that does not necessarily outweigh the benefits of attempting to establish a more definitive airway. A supraglottic airway device may be easier to place than an endotracheal tube (ETT) but still carries the risk of aspiration. For pediatric out-of-hospital cardiac arrests, bag-mask ventilation is sufficient for airway management compared to advanced airway interventions such as orotracheal intubation or supraglottic airway device placement. If bag-mask ventilation is optimized and remains ineffective, a more advanced airway strategy should be considered. Bag-mask ventilation has not been proven to be associated with inferior outcomes compared to advanced airway interventions, assuming it is performed by providers with the proper training and experience. Therefore, bag-mask ventilation is a reasonable alternative to these strategies. It must be noted that no recommendations for or against the use of advanced airway interventions for pediatric in-hospital cardiac arrest are provided. Additionally, no current recommendations about which advanced airway intervention is superior, in either the out-of-hospital or in-hospital settings, are provided.
Needle cricothyrotomy (B) is unnecessary in a patient who can be adequately ventilated with a bag-valve mask. Similarly, placement of a supraglottic airway device (C) or an endotracheal tube (D), both of which carry increasing levels of risk, are not necessary for a patient who can be adequately oxygenated and ventilated with bag-mask ventilation.