Make certain the CPR and airway management are being done properly. When I started our protocol said to intubate immediately. On arrival, I would turn my back on the code and take the two minutes it takes to get my intubation roll out, unzip everything, take everything out, open the packages, assemble everything and then finally approach the patient. Now I watch the compressions and the ventilations. If only one person is doing the bag valve mask (assuming we are not doing passive ventilations), I grab someone else to hold the seal while the other squeezes the bag. Make certain they are not hyperventilating. Try using a pediatric ambu bag instead of an adult. Make certain a properly sized oral pharyngeal or nasal pharyngeal airway is in place and that the airway is held open.
Watch the CPR. Are the hands positioned properly? Are the compressions to an adequate depth and at the proper rate?
Since compressions are what matters most, make certain your team is doing them properly. You are the coach. You are in charge. Bring that patient back to life!
Stay tuned for next cardiac arrest Pearl #5: Preattach ETCO2 Filter to ET Tube.