Assessing Airway Strategies: How different devices Face Masks, SGAs, and ETTs impact ventilation in CPR?
Recently published comparative study evaluated the efficacy of different airway devices-endotracheal tube (ETT), supraglottic airway device (SGA), and face mask-during cardiopulmonary resuscitation (CPR) in both flat and elevated head and thorax positions (HTE) using thawed, fresh-frozen human cadavers. The methodology employed a randomized crossover design, utilizing a mechanical ventilator to ensure standardized tidal volumes. The primary outcome analyzed was the expiratory tidal volume (VTe), normalized for predicted body weight, with secondary outcomes including inspiratory tidal volume (VTi), maximal inspiratory airway pressure (Pmax), and the difference between inspiratory and expiratory tidal volumes (VTi-VTe).
Findings and Analysis
Data from eight cadavers was assessed, resulting in a total of 2302 ventilation cycles being analyzed. The findings indicated that in the flat position, VTe was highest with ETT (7.66 ± 3.75 mL/kg) compared to SGA (5.01 ± 3.14 mL/kg) and face mask (5.63 ± 2.83 mL/kg). A mixed linear model analysis revealed statistically significant differences between the different ventilation devices in regards to VTe, VTi, Pmax, and VTi-VTe (p < 0.001). Notably, ETT consistently outperformed both SGA and face mask across these metrics. When comparing the effects of body positioning, the elevated position led to improved ventilation outcomes overall, with higher VTe noted in all groups when shifted from flat to HTE (p < 0.001). In the flat position, ETT ventilation recorded higher inspiratory pressures and lower leakage compared to SGA and face mask, which presented higher leakage values.
Importance of Efficient Ventilation
The study underscores the need for efficient ventilation during CPR, emphasizing that inadequate ventilation is linked to poor patient outcomes. Despite ETT being established as the gold standard, the results indicated that both face mask and SGA yielded lower VTe and increased leakage compared to ETT, presenting challenges for effective ventilation during CPR.
Implications for Future Research
Furthermore, the research highlighted that head and thorax elevation can reduce airway leakage and improve tidal volume delivery. The use of a systematic approach to measure ventilation efficacy and the influence of varying positions during CPR underscores a crucial factor in enhancing resuscitation outcomes. This study serves as a basis for future clinical investigations to validate these findings and improve airway management strategies during CPR in real-life settings.
Key Points
- A comparative study used a randomized crossover design to evaluate the efficacy of endotracheal tube (ETT), supraglottic airway device (SGA), and face mask during cardiopulmonary resuscitation (CPR) in both flat and elevated head and thorax positions using thawed, fresh-frozen human cadavers.
- The primary outcome was the expiratory tidal volume (VTe) normalized for predicted body weight, with secondary outcomes including inspiratory tidal volume (VTi), maximal inspiratory airway pressure (Pmax), and the difference between inspiratory and expiratory tidal volumes (VTi-VTe).
- Analysis of data from eight cadavers resulted in 2302 ventilation cycles, revealing that VTe was significantly higher with ETT (7.66 ± 3.75 mL/kg) compared to SGA (5.01 ± 3.14 mL/kg) and face mask (5.63 ± 2.83 mL/kg), with statistical significance (p < 0.001) across all measured metrics (VTe, VTi, Pmax, and VTi-VTe).
- The elevation of head and thorax (HTE) improved ventilation outcomes, showing higher VTe across all devices when shifting from flat to elevated position (p < 0.001), highlighting the importance of positioning in effective ventilation.
- In the flat position, ETT showed higher inspiratory pressures and lower leakage rates compared to SGA and face mask, which experienced greater leakage and lower tidal volume delivery.
- The study emphasizes the need for effective ventilation methods during CPR, indicating that while ETT remains the gold standard, both SGA and face mask showed limitations in performance. It also suggests that future research is necessary to further explore airway management strategies in CPR to enhance patient outcomes in real-life scenarios.
Reference –
N. Segond et al. (2025). EFFECT OF DIFFERENT AIRWAY DEVICES ON VENTILATION DURING CARDIOPULMONARY RESUSCITATION.. *Resuscitation*,110584 . https://doi.org/10.1016/j.resuscitation.2025.110584.
