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

UNLABELLED: 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.

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.