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 (VT) 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), and NextStep™ resuscitator. Randomized crossover animal trial uses 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™, (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. Resuscitation using an ETT and CC + SI resulted in a gain in VT, irrespective of ventilation device. In contrast, resuscitation with an ETT or SGA and 3:1 C:V resulted in a loss in VT 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 VT gain, regardless of ventilation device. Substantial leak during chest compressions with an SGA may hinder effective VT delivery.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> What is known: •A supraglottic airway device can be used as an alternative airway during neonatal resuscitation, but ventilation efficacy during chest compressions remains unknown. </entry> </row> <row> <entry align="left" nameend="c2" namest="c1"> What is new: •Chest compressions result in substantial leak via the supraglottic airway, hindering effective tidal volume delivery during neonatal resuscitation. •Neonatal resuscitation using the 3:1 compression-to-ventilation technique leads to tidal volume loss, regardless of ventilation device, but the alternative technique of continuous chest compressions with sustained inflations results in improved tidal volume delivery. </entry> </row> </tbody> </tgroup> </Table>

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

期刊论文
发表日期：

2025年7月8日

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Brandon Kowal,
Megan O’Reilly,
Raza Hyderi,
Marwa Ramsie,
Tze-Fun Lee,
Georg M. Schmölzer

摘要

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), and NextStep™ resuscitator. Randomized crossover animal trial uses 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™, (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. 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 an SGA may hinder effective V_T delivery.

What is known:

•A supraglottic airway device can be used as an alternative airway during neonatal resuscitation, but ventilation efficacy during chest compressions remains unknown.

What is new:

•Chest compressions result in substantial leak via the supraglottic airway, hindering effective tidal volume delivery during neonatal resuscitation.

•Neonatal resuscitation using the 3:1 compression-to-ventilation technique leads to tidal volume loss, regardless of ventilation device, but the alternative technique of continuous chest compressions with sustained inflations results in improved tidal volume delivery.