Clinical paper| Volume 148, P32-38, March 01, 2020

Download started.


Supraglottic airway devices variably develop negative intrathoracic pressures: A prospective cross-over study of cardiopulmonary resuscitation in human cadavers


      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).


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lurie K.G.
        • Zielinski T.
        • McKnite S.
        • Sukhum P.
        Improving the efficiency of cardiopulmonary resuscitation with an inspiratory impedance threshold valve.
        Crit Care Med. 2000; 28: N207-9
        • Moore Johanna C.
        • Holley J.
        • Segal N.
        • et al.
        Consistent head up cardiopulmonary resuscitation hemodynamics are observed across porcine and human cadaver translational models.
        Resuscitation. 2018; 132 (Epub 2018 April 24): 133-139
        • Kwon Y.
        • Debaty G.
        • Puertas L.
        • et al.
        Effect of regulating airway pressure on intrathoracic pressure and vital organ perfusion pressure during cardiopulmonary resuscitation: a non-randomized interventional cross-over study.
        Scand J Trauma Resusc Emerg Med. 2015; 23: 83
        • Shultz J.J.
        • Coffeen P.
        • Sweeney M.
        • et al.
        Evaluation of standard and active compression-decompression CPR in an acute human model of ventricular fibrillation.
        Circulation. 1994; 89: 684-693
        • Kleinman Monica E.
        • Brennan Erin E.
        • Goldberger Zachary D.
        • et al.
        American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132 (Originally published 3 November 2015): S414-35
        • Benjamini Yoav
        • Hochberg Yosef
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J R Stat Soc: Ser B (Methodol). 1995; 57: 289-300
        • Sugiyama Atsushi
        • Duval Sue
        • Nakamura Yuji
        • Yoshihara Katsunori
        • Yannopoulos Demetris
        Impedance threshold device combined with high-quality cardiopulmonary resuscitation improves survival with favorable neurological function after witnessed out-of-hospital cardiac arrest.
        Circ J. 2016; 80 (Epub 2016 September 9): 2124-2132
        • Duval Sue
        • Pepe Paul E.
        • Goodloe Jeffrey M.
        • Sugiyama Atsushi
        • Yannopoulos Demetris
        The CPR “Sweet Spot”: a target combination of optimal chest compression rate and depth to achieve survival with favorable neurological function after out of hospital cardiac arrest.
        Circulation J. 2016; 134 (Originally published 29 March 2018)A19230
        • Plaisance Patrick
        • Lurie Keith G.
        • Payen Didier
        Inspiratory impedance during active compression-decompression cardiopulmonary resuscitation: a randomized evaluation in patients in cardiac arrest.
        Circulation J. 2000; 101 (Originally published 7 March 2000): 990-994
        • Plaisance Patrick
        • Soleil Christian
        • Lurie Keith G.
        • et al.
        Use of an inspiratory impedance threshold device on a facemask and endotracheal tube to reduce intrathoracic pressures during the decompression phase of active compression–decompression cardiopulmonary resuscitation.
        Crit Care Med. 2005; 33: 990-994
        • Aufderheide T.P.
        • Frascone R.J.
        • Wayne M.A.
        • et al.
        Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial.
        Lancet. 2011; 377: 301-311
        • Plaisance P.
        • Soleil C.
        • Lurie K.G.
        • Vicaut E.
        • Ducros L.
        • Payen D.
        Use of an inspiratory impedance threshold device on a facemask and endotracheal tube to reduce intrathoracic pressures during the decompression phase of active compression-decompression cardiopulmonary resuscitation.
        Crit Care Med. 2005; 33: 990-994