Abstract
Aim of the study
Negative intrathoracic pressure (ITP) during the decompression phase of cardiopulmonary
resuscitation (CPR) is essential to refill the heart, increase cardiac output, maintain
cerebral and coronary perfusion pressures, and improve survival. In order to generate
negative ITP, an airway seal is necessary. We tested the hypothesis that some supraglottic
airway (SGA) devices do not seal the airway as well the standard endotracheal tube
(ETT).
Methods
Airway pressures (AP) were measured as a surrogate for ITP in seven recently deceased
human cadavers of varying body habitus. Conventional manual, automated, and active
compression-decompression CPR were performed with and without an impedance threshold
device (ITD) in supine and Head Up positions. Positive pressure ventilation was delivered
by an ETT and 5 SGA devices tested in a randomized order in this prospective cross-over
designed study. The primary outcome was comparisons of decompression AP between all
groups.
Results
An ITD was required to generate significantly lower negative ITP during the decompression
phase of all methods of CPR. SGAs varied in their ability to support negative ITP.
Conclusion
In a human cadaver model, the ability to generate negative intrathoracic pressures
varied with different SGAs and an ITD regardless of the body position or CPR method.
Differences in SGAs devices should be strongly considered when trying to optimize
cardiac arrest outcomes, as some SGAs do not consistently develop a seal or negative
intrathoracic pressure with multiple different CPR methods and devices.
Keywords
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Article info
Publication history
Published online: January 18, 2020
Accepted:
December 23,
2019
Received in revised form:
December 14,
2019
Received:
September 21,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
