Before intubation
- Call help early and prepare a peri-arrest plan.
- Optimize oxygenation, acid-base status, vasopressors/inotropes, and definitive PE/RV pathway per local protocol.
- Discuss PEEP/pressure risk before the tube.
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Airway situation
RV Failure / Pulmonary Embolism Airway
RV failure airways can arrest with induction, apnea, acidosis, hypoxia, and excessive intrathoracic pressure.
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Clinical-use limit: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment.
During intubation
- Use the best first attempt and minimize apnea.
- Transition gently to positive-pressure ventilation; avoid excessive pressures.
- Keep pressors/resuscitation running and monitor EtCO2/MAP closely.
After intubation
- Use RV-protective ventilator strategy and avoid unnecessary high PEEP/pressures.
- Continue definitive PE/RV therapy and reassess shock.
- Watch for sudden EtCO2 drop, hypotension, and arrest.
Common pitfalls
- Routine hypoxic airway approach without RV plan.
- High PEEP/pressures worsening preload/output.
- Ignoring acidosis and hypercarbia.