Comprehensive Summary
This study assessed whether supraglottic airway devices (SGAs) could serve as alternatives to tracheal intubation (TI) for delivering chest-compression-synchronized ventilation (CCSV) during continuous cardiopulmonary resuscitation. Three SGAs, Ambu® AuraGain™, LTS-D®, and i-gel®, were compared with TI using a randomized controlled cross-over design in 11 Thiel-embalmed cadavers. The primary endpoint was achieving an inspiratory pressure of pCCSV = 40 ± 3 mbar. Secondary results included expiratory tidal volume, mean/peak airway pressure, and leakage. Results showed that TI achieved higher pressures, larger tidal volumes, and less leakage compared with SGAs. Among the SGAs, LTS-D® and i-gel® performed better than Ambu® AuraGain™, though all SGAs were associated with higher leakage and lower likelihood of reaching target pressure.In some cadavers, ventilation failed regardless of the device used.
Outcomes and Implications
These findings suggest that while CCSV is feasible with certain SGAs, TI remains the most reliable method for intra-arrest ventilation. The results highlight both the risk of ventilation failure and the need for vigilant monitoring when SGAs are used, since inadequate tidal volumes may compromise effectiveness.The study informs resuscitation protocols by showing that CCSV with SGAs is possible but less dependable than TI, particularly in prehospital settings where SGAs are often first-line. Confirmatory trials in live patients are needed before SGAs can be recommended for CCSV in routine clinical practice.