Efficacy of supraglottic airway devices in Chest Compression Synchronized Ventilation during continuous resuscitation: A prospective randomized cross-over cadaver study.

Background: This study aimed to evaluate the efficacy of Chest-Compression-Synchronized-Ventilation (CCSV) using supraglottic airway devices (SGA) compared to tracheal intubation (TI) for ventilation during continuous resuscitation.

Methods: In this cross-over study, the lungs of adult Thiel-embalmed cadavers were initially recruited using TI. Subsequently, various SGA (Laryngeal-Mask=Ambu®AuraGain™, Laryngeal-Tube=LTS-D®, i-gel-Laryngeal-Mask=I-GEL®) and TI were applied in randomized order during continuous chest compressions. CCSV was delivered with a CCSV-Pressure (pCCSV)=40mbar, PEEP=3mbar, respiratory-rate (RR) synchronized with the chest compression rate. The primary endpoint was achieving a pCCSV=40±3mbar. Secondary endpoints included pCCSV, expiratory tidal (V) 1ml/kgBW and leakage volumes (V). Logistic regression models with random intercepts were used for the primary outcome, and linear mixed models were applied for secondary outcomes.

Results: Eleven cadavers were included. While two(18%) were successfully ventilated with all airway types, three(27%) could only be ventilated with an TI. Two cadavers(18%) could not be sufficiently ventilated with any of the airway devices including TI. When comparing TI and SGA, for TI a greater chance of reaching the target corridor of pCCSV (Odds Ratio(OR)=1.87;95%-Confidence-Interval(95%CI)=[0.91-3.83];P=0.0864) and a higher pCCSV was observed (regression-coefficient(RC)=2.99mbar;95%CI=[1.63-4.35];p<0.0001), along with a higher V (RC=42.42ml;95%CI=[32.07-52.27];p<0.0001), and a lower V (RC=-55.03%;95%CI=[-62.92-47.15];p<0.0001). In comparisons among the individual SGA, lower pCCSV-values were observed for Ambu®AuraGain™ versus I-GEL® (RC=-2.58mbar; 95%CI=[-4.04--1.13];p=0.0006), Ambu®AuraGain™ versus LTS-D® (RC=-1.73mbar;95%CI=[-3.18--0.27];p=0.0204), and LTS-D® versus I-GEL® (RC=-0.86mbar;95%CI=[-2.30-0.59];p=0.2434).

Conclusion: SGA were associated with a lower likelihood of reaching the target range of pCCSV, lower V, and higher V. Regardless the airway device, CCSV-failure is possible emphasizing the need for vigilant respiratory monitoring REGISTRATION:: URL: https://www.

Clinicaltrials: gov Unique identifier number: NCT06306898.