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

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)=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 (Vte) 1ml/kgBW and leakage volumes (Vleak). 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)=2.99mbar;95%CI=[1.63-4.35];p<0.0001), along with a higher Vte (RC=42.42ml;95%CI=[32.07-52.27];p<0.0001), and a lower Vleak (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). SGA were associated with a lower likelihood of reaching the target range of pCCSV, lower Vte, and higher Vleak. Regardless the airway device, CCSV-failure is possible emphasizing the need for vigilant respiratory monitoring REGISTRATION:: URL: https://www. gov Unique identifier number: NCT06306898.