Preface: I am a lower tier provider (paramedic) in an ER. I come from the prehospital environment where I was in charge of many CPR's. I worked for a busy system with strict oversight and high standards from the medical directors and their office. We did a lot of CE's and a lot of case reviews, and our protocols were based on the latest evidence-based data.
My issue: This particular ER doc has us stop compressions while he makes an intubation attempt. He did accomplish the ETT in probably 30 seconds, but I thought it was a pretty well established and pervasive concept that chest compressions are superior and should not be paused for the sake of airway interventions. A study my prehospital organization participated in, called the Pragmatic Airway Resuscitation Trial (https://clinicaltrials.gov/ct2/show/NCT02419573), shows that ultimately you get the same outcome whether you intubate with an ETT or use a King LT.
My Question: I'm not sure how to bring this up to this attending ER doctor. I feel very strongly about chest compressions not being stopped for airway interventions as I have intubated plenty of patients while CPR was continuous. I actually feel like we are doing the patient no good at all and even causing slight harm by ceasing chest compressions for a solid 30-45 seconds just to intubate. It only takes a 3-second pause for 30 seconds worth of CPR building up blood pressure to be lost and back to 0. Any ideas on how to present this to him?
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