Effect of Early Supraglottic Airway Device Insertion on Chest Compression Fraction during Simulated Out-of-Hospital Cardiac Arrest: Randomised Controlled Trial

Loric Stuby, Laurent Jampen, Julien Sierro, Maxime Bergeron, Erik Paus, Thierry Spichiger, Laurent Suppan, David Thurre, Loric Stuby, Laurent Jampen, Julien Sierro, Maxime Bergeron, Erik Paus, Thierry Spichiger, Laurent Suppan, David Thurre

Abstract

Early insertion of a supraglottic airway (SGA) device could improve chest compression fraction by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of out-of-hospital cardiac arrest. A multicentre, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF quality of compressions and ventilations parameters were also compared. Among thirteen teams of two participants, the early insertion of an i-gel® resulted in higher CCFs during the first two minutes (89.0% vs. 83.6%, p = 0.001). Overall and per-cycle CCF were consistently higher in the i-gel® group, even after the 30:2 alternation had been resumed. In the i-gel® group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs. 5.2 cm, p = 0.007). This latter issue must be addressed before clinical trials can be considered.

Keywords: CPR; Cardiac Arrest; Chest Compression Fraction; Emergency Medical Services; Supraglottic Airway Device; airway; i-gel®; paramedics; prehospital; resuscitation.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript or in the decision to publish the results.

Trial Registration: NCT04736446 (3 February 2021).

Figures

Figure 1
Figure 1
Study sequence.
Figure 2
Figure 2
Study flowchart.
Figure 3
Figure 3
Proportions of compressions below, within and above depth target value.
Figure 4
Figure 4
Proportions of ventilations below, within and above volume target value.

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