Efficacy of supraglottic airway devices in chest compression synchronized ventilation during continuous resuscitation: a prospective randomized cross-over cadaver study.

Abstract

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. 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) = 40 mbar, PEEP = 3 mbar, respiratory-rate (RR) synchronized with the chest compression rate. The primary endpoint was achieving a pCCSV = 40 ± 3 mbar. Secondary endpoints included pCCSV, expiratory tidal (V_te) 1 ml/kgBW and leakage volumes (V_leak). Logistic regression models with random intercepts were used for the primary outcome, and linear mixed models were applied for secondary outcomes. 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) = 2.99 mbar; 95 %CI = [1.63-4.35]; p < 0.0001), along with a higher V_te (RC = 42.42 ml; 95 %CI = [32.07-52.27]; p < 0.0001), and a lower V_leak (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 = -2.58 mbar; 95 %CI = [-4.04--1.13]; p = 0.0006), Ambu®AuraGain™ versus LTS-D® (RC = -1.73 mbar; 95 %CI = [-3.18--0.27]; p = 0.0204), and LTS-D® versus I-GEL® (RC = -0.86 mbar; 95 %CI = [-2.30-0.59]; p = 0.2434). SGA were associated with a lower likelihood of reaching the target range of pCCSV, lower V_te, and higher V_leak. Regardless the airway device, CCSV-failure is possible emphasizing the need for vigilant respiratory monitoring. URL: https://www. gov. Unique identifier number: NCT06306898.