When an advanced airway (such as an endotracheal tube or supraglottic airway like an LMA) is in place during CPR, the procedure differs primarily in how chest compressions and ventilations are coordinated:

• Chest Compressions: Compressions are performed continuously at a rate of 100 to 120 per minute without pausing for breaths. Full chest recoil should be allowed between compressions, and interruptions should be minimized to less than 10 seconds total

• Ventilations: Breaths are given independently of compressions at a rate of about 8 to 10 breaths per minute (one breath every 6 to 8 seconds). Each breath lasts about 1 second and is delivered through the advanced airway device using a bag-valve mask or ventilator. There is no need to synchronize breaths with compressions, and chest compressions are not stopped during ventilation

• No Compression-to-Breath Ratio: Unlike basic CPR where a 30:2 compression-to-ventilation ratio is used, with an advanced airway in place, compressions are continuous and ventilations are given asynchronously without pausing compressions

• Airway Confirmation and Monitoring: Proper placement of the advanced airway must be confirmed before starting CPR, typically by visualization, auscultation, or end-tidal CO2 monitoring. Ventilation effectiveness is monitored via chest rise and capnography if available

In summary, CPR with an advanced airway involves continuous chest compressions at the standard rate with asynchronous ventilations delivered through the airway device, eliminating pauses in compressions for breaths and improving oxygen delivery efficiency during resuscitation