ACLS Airway Management

ACLS Airway Management: From Bag-Mask to Advanced Airway

Airway management is tested on its own on every ACLS course, and it runs through respiratory arrest, cardiac arrest and post-arrest care. Good basic airway management comes before any advanced device.

In short

Open the airway, use an oropharyngeal or nasopharyngeal airway if needed, ventilate with a bag-mask without over-ventilating, consider an advanced airway when appropriate, and confirm it with waveform capnography.

Basic airway

Head tilt–chin lift or jaw thrust, suction, and airway adjuncts: an oropharyngeal airway for an unconscious patient without a gag reflex, or a nasopharyngeal airway. Then bag-mask ventilation — see bag-mask ventilation.

Respiratory arrest

A patient with a pulse but no effective breathing receives about one breath every 6 seconds, with pulse checks every 2 minutes. Without treatment, respiratory arrest progresses to cardiac arrest.

Advanced airways

Tracheal intubation or a supraglottic device such as a laryngeal mask airway may be placed by trained providers. The decision weighs the benefit against interruptions to compressions. Once placed during CPR, give about one breath every 6 seconds while compressions continue without pauses.

Confirmation

Confirm placement with clinical assessment and continuous waveform capnography. See capnography in ACLS.

Common pitfalls

  • Over-ventilation, which reduces blood return to the heart.
  • Long pauses in compressions to place an airway.
  • Failing to recognise a displaced tube — capnography helps.

Airway care continues in post-arrest care. Sedation settings have their own guide: ACLS for sedation teams.

This guide summarises what the ACLS course teaches for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s policies.

Other life support and first aid courses: BLS Course · PALS Course · First Aid Course · Training calendar

Frequently asked questions

Is intubation required in ACLS?

No. Good bag-mask ventilation is acceptable; advanced airways are placed by trained providers when appropriate.

How often are breaths given with an advanced airway?

About one every 6 seconds, with continuous compressions.

How is an advanced airway confirmed?

Clinical assessment plus continuous waveform capnography.

What is an OPA used for?

Keeping the airway open in an unconscious patient without a gag reflex.

Is airway management tested in ACLS?

Yes, there is an airway skills test.

Practise these algorithms on an AHA ACLS course

Reading an algorithm is not the same as running one. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site ACLS and a two-year AHA ACLS Provider eCard.

See ACLS dates and register ACLS course overview Group booking enquiry

Sources and further reading

What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.

Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.