Tidal volume delivery during chest compression with either an endotracheal tube or supraglottic airway in a porcine animal model

Purpose: The 2023 Consensus of Science and Treatment Recommendations states that a supraglottic airway (SGA) device can be used to deliver positive pressure ventilation. However, it is unclear if a SGA can effectively be used during chest compressions. We aimed to compare tidal volume (V _T ) delivery during either chest compressions with sustained inflations (CC+SI) or 3:1 compression-to-ventilation (3:1 C:V) technique with SGA and endotracheal tube (ETT) using various ventilation devices: T-piece, self-inflating bag (SIB), flow-inflating bag (FIB), NextStep ^TM resuscitator. Methods: Randomized crossover animal trial using seven mixed-breed piglets (1-3 days old; 1.8-2.4 kg). Piglets were euthanized to eliminate any potential interference with gasping or spontaneous breathing, and randomized to a sequence of resuscitation techniques: 1) CC+SI with T-piece, 2) CC+SI with FIB, 3) CC+SI with SIB, 4) CC+SI with NextStep ^TM , 5) 3:1 C:V with T-piece, 6) 3:1 C:V with FIB, and 7) 3:1 C:V with SIB. Resuscitation was performed for 1 min per technique via the SGA and then ETT. Respiratory parameters were recorded. Results: Resuscitation using an ETT and CC+SI resulted in a gain in V _T , irrespective of ventilation device. In contrast, resuscitation with an ETT or SGA and 3:1 C:V resulted in a loss in V _T across all ventilation devices. There was substantial leak with the SGA, regardless of the ventilation device or compression technique. Conclusions: Using the CC+SI technique for resuscitation paired with an ETT resulted in V _T gain, regardless of ventilation device. Substantial leak during chest compressions with a SGA may hinder effective V _T delivery.