Effectiveness of extraglottic airway device in Chest Compression Synchronized Ventilation during continuous resuscitation: A prospective randomized cadaver study

Background Chest Compression Synchronized Ventilation (CCSV) is a new ventilation mode designed to improve both ventilation and cardiac output during cardio-pulmonary resuscitation. So far, the use of CCSV with extraglottic airway devices (EGA) is scarcely investigated. This study evaluates the effectiveness of EGA compared to endotracheal Intubation (ETI) for ventilation parameters during CCSV in continuous resuscitation. Methods The lungs of Thiel-embalmed cadavers of adult body donors were initially ventilated using ETI and bronchoscopy. Subsequently, various EGA (Laryngeal Mask, Laryngeal Tube, iGel Laryngeal Mask) and ETI were applied in randomized order during continuous chest compressions using corpuls-cpr. CCSV was applied with a pCCSV = 40 mbar, PEEP = 3 mbar, respiratory rate = chest compression rate. The primary endpoint was achieving a target CCSV pressure (pCCSV) of 40 ± 3 mbar. Secondary endpoints included pCCSV, expiratory tidal volumes (V _te ) and leakage volumes (V _leak ). Results Eleven cadavers were included. The mean pCCSV was 41.3 ± 4.4 mbar for ETI and 38.3 ± 4.1 mbar for EGA. Mean V _te was 98.0 ± 42.4 ml for endotracheal intubation as compared to 55.7 ± 43.5 ml for extraglottic airway devices. Mean V _leak for endotracheal intubation was 5.4 ± 6.7% compared to 60.4 ± 33.0% for EGA. Endotracheal intubation showed higher chances of reaching the pCCSV target, along with higher V _te and lower leakage volumes Conclusion While extraglottic airway devices demonstrated comparable performance to ETI for achieving pCCSV, EGA were associated with a lower likelihood of reaching the target pCCSV range, lower V _te , and higher V _leak . Further studies are warranted to evaluate the clinical implications of these findings. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: number NCT06306898