Effectiveness of extraglottic airway device in Chest Compression Synchronized Ventilation during continuous resuscitation: A prospective randomized cadaver study

Effectiveness of extraglottic airway device in Chest Compression Synchronized Ventilation during continuous resuscitation: A prospective randomized cadaver study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of extraglottic airway device in Chest Compression Synchronized Ventilation during continuous resuscitation: A prospective randomized cadaver study Tamar Gelashvili, Beate Brand-Saberi, Mahsa Darvishali, Annika Hoyer, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6272494/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Chest Compression Synchronized Ventilation (CCSV) is a new ventilation mode designed to improve both ventilation and cardiac output during cardio-pulmonary resuscitation. So far, the use of CCSV with extraglottic airway devices (EGA) is scarcely investigated. This study evaluates the effectiveness of EGA compared to endotracheal Intubation (ETI) for ventilation parameters during CCSV in continuous resuscitation. Methods The lungs of Thiel-embalmed cadavers of adult body donors were initially ventilated using ETI and bronchoscopy. Subsequently, various EGA (Laryngeal Mask, Laryngeal Tube, iGel Laryngeal Mask) and ETI were applied in randomized order during continuous chest compressions using corpuls-cpr. CCSV was applied with a pCCSV = 40 mbar, PEEP = 3 mbar, respiratory rate = chest compression rate. The primary endpoint was achieving a target CCSV pressure (pCCSV) of 40 ± 3 mbar. Secondary endpoints included pCCSV, expiratory tidal volumes (V te ) and leakage volumes (V leak ). Results Eleven cadavers were included. The mean pCCSV was 41.3 ± 4.4 mbar for ETI and 38.3 ± 4.1 mbar for EGA. Mean V te was 98.0 ± 42.4 ml for endotracheal intubation as compared to 55.7 ± 43.5 ml for extraglottic airway devices. Mean V leak for endotracheal intubation was 5.4 ± 6.7% compared to 60.4 ± 33.0% for EGA. Endotracheal intubation showed higher chances of reaching the pCCSV target, along with higher V te and lower leakage volumes Conclusion While extraglottic airway devices demonstrated comparable performance to ETI for achieving pCCSV, EGA were associated with a lower likelihood of reaching the target pCCSV range, lower V te , and higher V leak . Further studies are warranted to evaluate the clinical implications of these findings. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: number NCT06306898 Chest Compression Synchronized Ventilation Extragloztic airway devices Cardiopulmonary resuscitation Endotracheal Intubation Intra-arrest ventilation Figures Figure 1 Take home massage When comparing Chest Compression Synchronized Ventilation with endotracheal intubation versus extraglottic airway devices, a higher Chest-Compression-Synchronized-Ventilation pressure was observed along with a greater chance of reaching the target corridor, a higher tidal volume, and a lower leakage volume. Regarding to Chest-Compression-Synchronized-Ventilation pressure, the comparison between extraglottic airway devices with endotracheal intubation, particularly for IGEL and laryngeal tube, showed evidence for equivalence with moderate agreement. Research of Chest Compression Synchronized Ventilation (CCSV) using endotracheal intubation compared to extraglottic airway devices. Higher CCSV pressures were observed, along with a greater likelihood of reaching target corridors, increased tidal volumes, and reduced leakage volumes, wenn using entotracheal intubation. Bland-Altman analysis indicated moderate agreement between intubation and extraglottic devices. Notably, lower CCSV pressure values were recorded for laryngeal masks versus IGEL and laryngeal tubes. The findings suggest that extraglottic devices can provide results comparable to endotracheal intubation, particularly for IGEL and laryngeal tubes, indicating a potential for individualized intra-arrest ventilation strategies. Further studies are essential for clinical implications! Introduction Out-of-hospital cardiac arrest (OHCA) holds considerable societal importance because of its high mortality and morbidity rates. 1 , 2 While substantial research has focused on optimal initial airway management, intra-arrest ventilation (IRV) remains underexplored. 3 – 5 In addition to techniques such as bag-device ventilation (BDV) and the widely used intermittent positive pressure ventilation (IPPV), 6 , 7 Chest Compression Synchronized Ventilation (CCSV) has emerged in recent years as an innovative ventilation mode that was specifically developed for IRV. 8 CCSV is a pressure-controlled ventilation mode that resembles assisted spontaneous ventilation. 9 During CCSV, the respirator uses a selectable inverse trigger, detects individual chest compressions and automatically delivers synchronized, pressure-controlled, inspiratory ventilation breaths lasting 205ms with each chest compression. 9 , 10 The inspiratory pressure (pCCSV) is the key parameter of CCSV and can be set in the range of 40mbar to 60mbar. 9 , 10 Compared with IPPV and biphasic positive airway pressure, CSSV has demonstrated superior arterial and cerebral oxygenation, as well as significantly increased arterial blood pressure during compression. 9 – 11 Despite these potential advantages, to date, CCSV has only been evaluated and approved for IRV in conjunction with endotracheal intubation (ETI). Data on the effects of EGA on target parameters of CSSV are lacking, although EGA are frequently used for initial airway protection during CPR, especially in non-physician-dominated paramedic systems. 12 – 15 Therefore, the present study compared ventilation parameters during CCSV between ETI and different EGA in a human cadaver model. Materials and Methods This study was approved by the ethics committee of Ruhr University Bochum in Ostwestfalen-Lippe, Bad Oeynhausen, Germany (Chairman: Prof. Dr. Wolfgang Burchert) on February 13, 2024 (Ref. 2024 − 1183), and was registered at ClinicalTrials.gov (registration number NCT06306898). It was conducted in March and August 2024 at the Institute of Anatomy of Ruhr University Bochum, Germany, Department of Anatomy and Molecular Embryology. This study was reported in accordance with the current CONSORT guidelines. 16 Cadaver Selection and Preparation Cadavers from adult body donors that were fixed via the Thiel procedure were included. The Thiel procedure was developed by Professor Walter Thiel from Graz, Austria, and first described in 1992. 17 This procedure involves intravascular injection and storage of the body donor in a special preservation solution, 17 , 18 thus preserving a lifelike anatomical appearance and tissue elasticity. 18 Such cadavers are often used for training medical procedures and for evaluating respiratory mechanics and dynamic pressures during chest compressions. 19 , 20 The exclusion criteria were as follows: body donors with abnormal airways, a history of tracheostomy, a history of adult respiratory distress syndrome (ARDS), severe lung or thoracic injuries (i.e., pneumothorax), and/or severe aspirations. An external postmortem examination ensured compliance with these criteria. Study Design ETI was performed via direct laryngoscopy (Mallinckrodt tubes; male ID = 8.0mm, female ID = 7.0mm), followed by bronchoscopy with an Ambu aScope 4 Broncho Slim 2.8 mm ® ( Ambu GmbH, Steinkopfstraße 4, 61231 Bad Nauheim https://www.ambu.com ) to verify the tube position and clear secretions. Lungs were recruited for four minutes via pressure-controlled ventilation with a MEDUMAT Standard 2 ventilator ® (WEINMANN Emergency Medical Technology GmbH + Co. KG, Frohbösestraße 12, 22525 Hamburg, Germany, https://www.Weinmann-emergency.com ) (P insp =3mbar, PEEP = 12mbar, respiratory rate = 10/min). After successful recruitment, four different airway devices were applied in a randomized order to perform CCSV: 1. ETI; 2. laryngeal tube = LTSD ® (LTS-D, VBM Medizintechnik GmbH, Einsteinstr. 1 72172 Sulz a. N., https://www.vbm-medical.de ); 3. laryngeal mask = LMA ® (Ambu AuraGain, Steinkopfstraße 4, 61231 Bad Nauheim, https://www.ambu.de ); and 4. i-Gel laryngeal mask = IGEL ® (Intersurgical GmbH, Siegburger Str. 39, 53757 Sankt Augustin, https://www.intersurgical.com ). The size of each EGA was selected based on the manufacturer's guidelines, with the cuff pressure limited to a maximum of 40 mmH 2 O for all airway devices. Each device’s position was verified via bronchoscopy, and lung recruitment was repeated with five manual ventilation breaths via a WEINMANN MEDUtrigger before initiating CCSV. Ventilation and Chest Compressions Ventilation was performed with the MEDUMAT Standard 2 Ventilator in CCSV mode (pCCSV = 40mbar; PEEP = 3mbar; respiratory rate (RR) = chest compression rate) for four minutes per device. Chest compressions were performed using the mechanical chest compression device corpuls cpr ® (corplus GS Elektromedizinische Geräte G. Stemple GmbH, Hauswiesenstraße 26, 86916 Kaufering, https://www.corpuls.world/en/pr ) with a compression frequency of 100/min and a pressure depth of 5.5cm. Endpoints The primary endpoint was the achievement of a pCCSV of 40 ± 3mbar within the tolerance range specified by the manufacturer. The secondary endpoints included the mean pressure (P mean ) in Millibar (mbar), peak pressure (P peak ) in mbar, expiratory minute volume (M Ve ) in Liter (l), expiratory tidal volume (V te ) in Milliliter (ml), leakage volume (V leak ) in % and respiratory rate (RR). Statistical Analyses Descriptive analyses were performed first. Continuous variables are expressed as the mean and standard deviation, and categorical variables are expressed as frequencies and proportions. To analyze the primary endpoint, logistic regression analysis with a random intercept was conducted to account for potential within-cadaver correlations. Furthermore, Bland‒Altman analysis was conducted to evaluate the level of agreement between ETI and EGA in terms of the pCCSV. 21 Additionally, as the manufacturer allows a tolerance range of 37-43mbar for the set pCCSV of 40mbar, we used equivalence tests to determine whether differences in the pCCSV between ETI and EGA fell within the predefined range of -6 to 6. To analyze the secondary outcomes, we used linear mixed regression models with random intercepts. The effect measures for all analyses were odds ratios (OR) or regression coefficients (RC) with 95% confidence intervals (95%CI) and p values (p) if appropriate. A p-value ≤ 0.05 was considered significant. All analyses were performed using the statistical software SAS 9.4® (SAS Institute Inc., Cary, NC). Results Among the twelve cadavers initially assessed for eligibility, eleven were ultimately included in the study. One cadaver was excluded because of a preexisting pneumothorax. Supplement 1 shows the flowchart of the study procedure after all the inclusion and exclusion criteria were applied. Characteristic of body donors TheCharacteristicof included body donors is presented in supplement 2. while Table 1 summarizes the descriptive statistics of the measured ventilation parameters across airway devices. Supplementary materials 3–13 provide detailed information on the ventilation parameters for each individual donor stratified by device. Table 1 Descriptive statistics of the measured ventilation parameters across airway devices. ETI 1 (n = 44) [mean±SD] EGA 2 (n = 131) [mean±SD] IGEL 3 (n = 44) [mean±SD] LMA 4 (n = 43) [mean±SD] LTSD 5 (n = 44) [mean±SD] CCSV 6 pressure (mbar) 41.3±4.4 38.3±4.1 39.5±4.0 36.9±2.7 38.6±4.9 Mean pressure (mbar) 21.2±3.9 18.4±23.0 18.7±3.1 18.1±2.5 18.4±3.3 Peak pressure (mbar) 48.7±7.9 43.2±3.9 44.1±4.0 41.9 ± 2.5 43.6±4.5 Expiratory minute volume (l) 9.1±4.2 5.1±3.9 5.8± 4.0 3.82±3.6 5.8±3.9 Expiratory tidal volume (ml) 98.0±42.4 55.7±43.5 64.7±47.2 41.7±40.2 60.3±40.2 Leakage volume (%) 5.4±6.7 60.4±33.0 50.7±31.5 77.1±26.3 53.8±34.8 Respiratory Rate 90.3±14.4 73.9±31.7 78.8±30.6 62.7±34.0 79.9±28.2 Legend: 1 ETI-Endotracheal Intubation; 2 EGA-Extraglottic Airway Device; 3 IGE-Igel Laryngeal mask; 4 LMA-Laryngeal Mask; 5 LTSD-Laryngeal Tube; 6 CCSV-Chest-Compression-Synchronized-Ventilation; Ventilation Performance Comparison When comparing ETI to EGA, the Chance of achieving the target pCCSV range was lower when using the EGA than when using ETI: IGEL (OR = 0.82; 95%CI = 0.34-2.00; p = 0.0256); LMA (OR = 0.25; 95%CI = 0.10–0.63; p < 0.0001); and LTSD (OR = 0.68; 95%CI = 0.28–1.62; p = 0.00012). When comparing the individual EGA, LMA demonstrated a significantly lower chance of achieving the target pCCSV than IGEL (OR = 0.29; 95%CI = 0.11–0.75; p = 0.0111) and LTSD (OR = 0.358; 95%CI = 0.140–0.971; p = 0.0326). No significant difference in the chance of achieving the target pCCSV was observed between LTSD and IGEL (OR = 0.81; 95%CI = 0.33-2.00; 0.6513). EGA had a lower V te (RC = 42.42; 95%CI = 32.07–52.77; p < 0.0001); and a higher V leak (RC=-55.03; 95%CI=-62.92–47.15; p < 0.0001). Comparison of Chest Compression Synchronized Ventilation Pressures The comparison between ETI and EGA revealed that ETI yielded greater pCCSV (RC = 2.99; 95%CI = 1.63–4.35; p < 0.001) than the EGA. Table 2 shows the results of the linear mixed models with random intercepts for the different ventilation parameters when comparing ETI and the EGA. Comparisons of the individual EGA and ETI revealed a lower pCCSV for each individual EGA than for ETI (IGEL vs. ETI RC=-1.85; 95%CI=-3.48–0.23; p = 0.0256; LMA vs. ETI RC=-4.45; 95%CI=-6.08–2.81; p < 0.0001; LTSD vs. ETI RC=-2.71; 95%CI=-4.33–1.09; p = 0.0012). Table 3 shows the results of the linear mixed models with random intercepts for the different ventilation parameters when comparing each individual EGA with ETI. Table 2 Results of linear mixed models with random intercept for the various ventilation parameters in the comparison of endotracheal intubation vs. extraglottic airway devices Covariable Regression coefficient 95%CI p-value CCSV 1 pressure (mbar) 2.99 1.63–4.35 < 0.0001 Mean pressure (mbar) 2.74 1.85–3.64 < 0.0001 Peak pressure (mbar) 5.45 3.80–7.09 < 0.0001 Expiratory minute volume (l) 4.00 3.04–4.97 < 0.0001 Expiratory tidal volume (ml) 42.42 32.07–52.77 < 0.0001 Leakage volume (%) -55.03 -62.92–47.15 < 0.0001 Respiratory rate 16.39 8.28–24.50 < 0.0001 Legend : 1 CCSV-Chest-Compression-Synchronized-Ventilation Table 3 Results of linear mixed models with random intercept for the various ventilation parameters in the comparison of the individual extraglottic airway devices vs. endotracheal intubation Variable Regression coefficient 95%CI p-value IGEL 1 vs. ETI 2 CCSV 3 pressure (mbar) -1.85 -3.48–0.23 0.0256 Mean pressure (mbar) -2.44 -3.55–1.34 < 0.0001 Peak pressure (mbar) -4.56 -6.56–2.56 < 0.0001 Expiratory minute volume (l) -3.32 -4.45–2.19 < 0.0001 Expiratory tidal volume (ml) -20.56 -45.43–21.12 < 0.0001 Leakage volume (%) 45.35 36.72–53.98 < 0.0001 Respiratory rate -11.47 -21.01–1.94 0.0187 LMA 4 vs. ETI 2 CCSV pressure -4.45 -6.08–2.81 < 0.0001 Mean pressure (mbar) -3.06 -4.17–1.96 < 0.0001 Peak pressure (mbar) -6.71 -8.72–4.70 < 0.0001 Expiratory minute volume (l) -5.34 -6.48–4.20 < 0.0001 Expiratory tidal volume (ml) -56.62 -68.85–44.39 < 0.0001 Leakage volume (%) 71.73 63.06–80.41 < 0.0001 Respiratory rate -27.55 -37.15–17.96 < 0.0001 LTSD 5 vs. ETI 2 CCSV 3 pressure (mbar) -2.71 -4.33–1.09 0.0012 Mean pressure (mbar) -2.73 -3.83–1.63 < 0.0001 Peak Pressure (mbar) -5.11 -7.10–3.11 < 0.0001 Expiratory minute volume (l) -3.38 -4.51–2.24 < 0.0001 Expiratory tidal volume (ml) -37.70 -49.86–25.55 < 0.0001 Leakage volume (%) 48.41 39.78–57.03 < 0.0001 Respiratory rate -10.40 -19.94–0.87 < 0.0327 Legend: 1 IGEL-Igel Laryngeal mask; 2 ETI-Endotracheal Intubation; 3 CCSV-Chest-Compression-Synchronized-Ventilation; 4 LMA-Laryngeal Mask; 5 LTSD-Laryngeal Tube Figure 1 presents the Bland‒Altman plot comparing pCCSV values between ETI and the individual EGA. The findings demonstrated a moderate level of agreement, with some observations falling outside the limits of agreement. The highest level of agreement was observed between LTSD and ETI. Equivalence tests revealed evidence of equivalence between ETI and the EGA within the predefined equivalence range of -6 to 6 except for the comparison of LMA and ETI (p = 0.0946). Statistically significant p values were observed for the following comparisons: ETI vs. overall EGA (p = 0.0217), IGEL vs. ETI (p = 0.0055), and LTSD vs. ETI (p = 0.0406). Comparisons between Extraglottic Airway Devices Table 4 shows the results of the linear mixed model with random intercepts for the 7 different ventilation parameters (pCCSV; P mean ; P peak ; M Ve ; V te ; V leak ; RR) when conducting comparison between the individual EGA. Lower pCCSV values were observed when comparing LMA and IGEL (RC=-2.58; 95%CI=-4.04–1.13; p = 0.0006), LMA and LTSD (RC=-1.73; 95%CI=-3.18–0.27; p = 0.0204) and LTSD and IGEL (RC=-0.86; 95%CI=-2.30-0.59; p = 0.2434). Table 4 Results of linear mixed models with random intercept for the various ventilation parameters in the comparison of the individual extraglottic airway devices against each other Variable Regression coefficient 95%CI p-value LMA 1 vs. IGEL 2 CCSV 3 pressure (mbar) -2.58 -4.04–1.13 0.0006 Mean pressure (mbar) -0.66 -1.66-0.34 0.1957 Peak pressure (mbar) -2.22 -3.65–0.80 0.0025 Expiratory minute volume (l) -2.03 -3.10–0.95 0.0003 Expiratory tidal volume (ml) -23.43 -35.48–11.38 0.0002 Leakage volume (%) 26.38 17.89–34.87 < 0.0001 Respiratory rate -16.08 -25.95–6.22 0.0016 LTSD 4 vs. IGEL 2 CCSV 3 pressure (mbar) -0.86 -2.30-0.59 0.2434 Mean pressure (mbar) -0.29 -1.28-0.71 0.5694 Peak pressure (mbar) -0.55 -1.97-0.87 0.4476 Expiratory minute volume (l) -0.06 -1.12-1.01 0.9144 Expiratory tidal volume (ml) -4.43 -16.41-7.54 0.4650 Leakage volume (%) 3.06 -5.38-11.50 0.4744 Respiratory rate 1.07 -8.74-10.87 0.8297 LMA 1 vs. LTSD 4 CCSV 3 pressure (mbar) -1.73 -3.18–0.27 0.0204 Mean pressure (mbar) -0.37 -1.37–0.63 0.4643 Peak pressure (mbar) -1.68 -3.11–0.25 0.0217 Expiratory minute volume (l) -1.97 -3.04–0.89 0.0004 Expiratory tidal volume (ml) -18.99 -31.05–6.94 0.0023 Leakage volume (%) 23.32 14.83–31.82 < 0.0001 Respiratory rate -17.15 -27.01–7.29 0.0008 Legend: 1 LMA-Laryngeal Mask; 2 IGEL-Igel Laryngeal mask; 3 CCSV-Chest-Compression-Synchronized-Ventilation; 4 LTSD-Laryngeal Tube Discussion This prospective, randomized study of human cadaver models compared key ventilation parameters detected during CCSV between different EGA and ETI. The EGA were associated with a lower chance of achieving the target pCCSV range than ETI. However, the results revealed evidence of equivalence in pCCSV between EGA (especially IGEL and LTSD) and ETI, with a moderate level of agreement. On the other hand, the EGAs had a lower likelihood of achieving the target pCCSV range, a lower V te and a higher V leak . The optimal airway management during CPR has been the subject of debate in recent decades. While ETI is widely considered to be the gold standard airway management technique, 7 it is often more technically challenging, typically requires advanced practitioner expertise. 15 , 22 – 24 Extraglottic airway devices such as the LTSD can be used for patients with cardiac arrest during both basic and advanced life support. In contrast, EGA are commonly used internationally in non-physician-based emergency medical services. 23 – 26 Since few studies have evaluated the influence of EGA on CCSV are still lacking, the present study examined this topic using a human cadaver model with the aim of providing unique insights into the feasibility of CCSV with different EGA. Role of the Chest Compression Synchronized Ventilation pressure The primary goal of IRV is to ensure adequate oxygenation and decarboxylation of the blood to prevent hypercapnia and respiratory acidosis with the lowest level of hemodynamic compromise. The inspiratory stroke applied by the pCCSV synchronized with chest compression prevents the loss of intrathoracic pressure via the airway device, thereby increasing the intrathoracic volume and generating a mean expiratory pressure of approximately 10mbar. 9 , 10 These mechanisms may explain the favorable effects of CCSV on oxygenation, decarboxylation, cerebral oxygenation and cardiac output that have been observed in animal studies. 9 – 11 An essential prerequisite for these physiological ventilatory effects in CCSV is the reliable application of the set pCCSV with the lowest possible V leak while triggering every chest compression effectively. In this study, evidence of equivalence between EGA and ETI was observed for the target range of pCCSV. Among the EGA examined herein, the IGEL and the LTSD appeared to be particularly suitable for CCSV. Role of the leakage volume The air leaks during the use of EGA has been extensively studied in anesthesiology, typically showing no clinically relevant effects on ventilation feasibility, as long as the applied V t ensures adequate alveolar ventilation and avoids critical gastric insufflation or regurgitation. 27 – 30 IRV generates significantly higher intrathoracic pressures due to chest compressions. These elevated pressures can impact both V t delivery and V leak when EGA are used, regardless of the ventilation mode. 31 , 32 Therefore, relevant V leak may reduce the potentially favorable effects on oxygenation, ventilation, and hemodynamics due to the physiological effects of CCSV. In the present study, V leak was observed for all airway devices used, including ETI, with significant V leak occurring for EGA. These V leak values could explain the lower V te and lower RR observed in the present study, which may have been due to insufficient triggering in the EGA. Individualized ventilation strategy for cardiac arrest While cardiac arrest is an extremely heterogeneous event that results from various underlying comorbidities, CPR according to guidelines represents a rather uniform, highly standardized therapy. 7 , 33 Recent advances, such as echocardiography-guided optimization of the compression point and depth as well as the level of adrenaline dosing, have highlighted the potential of individualized CPR to improve patient outcomes. 34 However, individualization is not yet incorporated into the guidelines for IRV. 7 Interestingly, in this study, some body donors easily achieved the target pCCSV with various EGA, yielding V te values comparable to those of ETI, whereas others exhibited insufficient ventilation even with ETI (see Supplement 3–13). The results provide unique insights into the effects of different airway devices on ventilation parameters during CCSV. These findings suggest that CCSV may be feasible in the context of individualized CPR when EGA are used to achieve ventilation therapy targets. This finding highlights the need for individualized consideration of ventilation parameters during CPR. Similar to the routine re-evaluation of heart rhythm, regular reassessment of ventilation parameters is essential to optimize resuscitation outcomes. Limitations The limitations of this study include the small sample size (i.e., eleven body donors); thus, this study could be underpowered, thereby limiting the generalizability of the findings. Second, the impact of Thiel fixation on the tissues of body donors could differ from the physiological responses in living resuscitation patients. However, Thiel fixation is widely used for similar studies. 18 , 19 As this study was conducted on human body donors, it was possible to assess respiratory pressure and respiratory mechanics; however, functional parameters such as paO 2 , paCO 2 , cerebral oxygenation and arterial blood pressure could not be measured. Despite this limitation, however, this study is the first to provide unique insights into the effects of different airway adjuncts during IRV with CCSV in a randomized and controlled human cadaver model. Conclusions The likelihood of achieving the target pCCSV range were lower when using the EGA than when using ETI. While the EGA demonstrated comparable performance to ETI in terms of achieving the target pCCSV, the EGA were associated with a lower V te and higher V leak . Future studies should explore these outcomes across diverse populations and clinical settings, assessing how individualized IRV can be optimized with EGA. Declarations Disclosures: M. Darvishali, V. Kuehn and C. Neuhaus are salaried employees of WEINMANN Emergency Medical Technology. The other authors declare no conflict of interest. Acknowledgments: The authors would like to thank the company VBM Medizintechnik GmbH for providing laryngeal tubes, as well as the company corpuls GS Elektromedizinische Geräte G. Stemple GmbH for the loan of a corpuls cpr mechanical resuscitation device. We would also like to thank Mr. Dieter Langelahn for providing technical support. Sources of Funding : This study was funded by WEINMANN Emergency Medical Technology GmbH + Co. KG, Frohbösestraße 12, 22525 Hamburg, Germany, https://www.Weinmann-emergency.com References Yan S, Gan Y, Jiang N, Wang R, Chen Y, Lou Z, Zong Q, Chen S. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis.  Crit Care. 2020;24(1):61. DOI:10.1186/s13054-020-2773-2 Myat A, Song KJ, Rea T. 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Esophageal seal is not the only consideration in supraglottic airway devices. Anesth Analg. 2008;107(1):344-5. DOI:10.1213/ane.0b013e3181784bda Vanwulpen M, Wolfskeil M, Duchatelet C, Hachimi-Idrissi S. Do manual chest compressions provide substantial ventilation during prehospital cardiopulmonary resuscitation? Am J Emerg Med. 2021;39:129-131. DOI:10.1016/j.ajem.2020.09.037 Ullmann H, Renziehausen L, Geil D, Sponholz C, Thomas-Rüddel D, Völker MT, Pietsch U, Krug N, Bercker S. The Influence of Positive End-Expiratory Pressure on Leakage and Oxygenation Using a Laryngeal Mask Airway: A Randomized Trial. Anesth Analg. 2022;135(4):769-776. DOI:10.1213/ANE.0000000000006115 Berg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, et al. Part 5 adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S685‐705. DOI:10.1161/CIRCULATIONAHA.110.970939 Huang Y, He Q, Yang LJ, Liu GJ, Jones A. Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest. Cochrane Database Syst Rev. 2014;2014(9):CD009803. DOI:10.1002/14651858.CD009803.pub2 Supplementary Files PlotBA1.png CONSORT2010Checklist.doc Supplement1.docx supplement2..docx Supplement3..docx Supplement4..docx Supplement5..docx Supplement6..docx Supplement7..docx Supplement8..docx Supplement9..docx Supplement10..docx Supplement11..docx Supplement12..docx Supplement13..docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6272494","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":434446518,"identity":"7e92499b-0326-48f3-95a6-afb2709eef31","order_by":0,"name":"Tamar Gelashvili","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0001-3094-2440","institution":"Johannes Wesling Klinikum Minden","correspondingAuthor":true,"prefix":"","firstName":"Tamar","middleName":"","lastName":"Gelashvili","suffix":""},{"id":434446519,"identity":"22fd4ea8-2902-4e18-a047-5a8cd609b7a5","order_by":1,"name":"Beate Brand-Saberi","email":"","orcid":"","institution":"Ruhr University Bochum: Ruhr-Universitat Bochum","correspondingAuthor":false,"prefix":"","firstName":"Beate","middleName":"","lastName":"Brand-Saberi","suffix":""},{"id":434446520,"identity":"b0c1d427-a46c-4549-9da7-ac57a90f4b0a","order_by":2,"name":"Mahsa Darvishali","email":"","orcid":"","institution":"WEINMANN Emergency Medical Technology GmbH + Co.KG","correspondingAuthor":false,"prefix":"","firstName":"Mahsa","middleName":"","lastName":"Darvishali","suffix":""},{"id":434446521,"identity":"2b51027a-79bf-4b4d-abfc-76cdc722c163","order_by":3,"name":"Annika Hoyer","email":"","orcid":"","institution":"University of Bielefeld: Universitat Bielefeld","correspondingAuthor":false,"prefix":"","firstName":"Annika","middleName":"","lastName":"Hoyer","suffix":""},{"id":434446522,"identity":"258b1dad-94a9-4ec4-8889-5f5dda87691f","order_by":4,"name":"Lydia Johnson Kolaparambil Varghese","email":"","orcid":"","institution":"Johannes Wesling Klinikum Minden","correspondingAuthor":false,"prefix":"","firstName":"Lydia","middleName":"Johnson Kolaparambil","lastName":"Varghese","suffix":""},{"id":434446523,"identity":"d4d021bd-569b-4bd0-8be2-520897429c45","order_by":5,"name":"Vanessa Kuehn","email":"","orcid":"","institution":"WEINMANN Emergency Medical Technology GmbH + Co. kG","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"","lastName":"Kuehn","suffix":""},{"id":434446524,"identity":"e0fb15ab-b359-4f1d-95ed-9c662fc56fc3","order_by":6,"name":"Jonas Lohmann","email":"","orcid":"","institution":"University of Bielefeld: Universitat Bielefeld","correspondingAuthor":false,"prefix":"","firstName":"Jonas","middleName":"","lastName":"Lohmann","suffix":""},{"id":434446525,"identity":"c729f5ff-cae6-48e5-8c1c-6b7824784e64","order_by":7,"name":"Christian Neuhaus","email":"","orcid":"","institution":"WEINMANN Emergency Medical Tecnology GmbH + Co. 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\u003cli\u003eWhen comparing Chest Compression Synchronized Ventilation with endotracheal intubation\u0026nbsp;versus extraglottic airway devices, a higher Chest-Compression-Synchronized-Ventilation pressure was observed along with a greater chance of reaching the target corridor, a higher tidal volume, and a lower leakage volume.\u003c/li\u003e\n \u003cli\u003eRegarding to Chest-Compression-Synchronized-Ventilation pressure, the comparison between extraglottic airway devices with endotracheal intubation, particularly for IGEL and laryngeal tube, showed evidence for equivalence with moderate agreement.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eResearch of Chest Compression Synchronized Ventilation (CCSV) using endotracheal intubation compared to extraglottic airway devices. Higher CCSV pressures were observed, along with a greater likelihood of reaching target corridors, increased tidal volumes, and reduced leakage volumes, wenn using entotracheal intubation. Bland-Altman analysis indicated moderate agreement between intubation and extraglottic devices. Notably, lower CCSV pressure values were recorded for laryngeal masks versus IGEL and laryngeal tubes. The findings suggest that extraglottic devices can provide results comparable to endotracheal intubation, particularly for IGEL and laryngeal tubes, indicating a potential for individualized intra-arrest ventilation strategies. Further studies are essential for clinical implications!\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eOut-of-hospital cardiac arrest (OHCA) holds considerable societal importance because of its high mortality and morbidity rates.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e While substantial research has focused on optimal initial airway management, intra-arrest ventilation (IRV) remains underexplored.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In addition to techniques such as bag-device ventilation (BDV) and the widely used intermittent positive pressure ventilation (IPPV), \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Chest Compression Synchronized Ventilation (CCSV) has emerged in recent years as an innovative ventilation mode that was specifically developed for IRV.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e CCSV is a pressure-controlled ventilation mode that resembles assisted spontaneous ventilation.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e During CCSV, the respirator uses a selectable inverse trigger, detects individual chest compressions and automatically delivers synchronized, pressure-controlled, inspiratory ventilation breaths lasting 205ms with each chest compression.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The inspiratory pressure (pCCSV) is the key parameter of CCSV and can be set in the range of 40mbar to 60mbar.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Compared with IPPV and biphasic positive airway pressure, CSSV has demonstrated superior arterial and cerebral oxygenation, as well as significantly increased arterial blood pressure during compression.\u003csup\u003e\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Despite these potential advantages, to date, CCSV has only been evaluated and approved for IRV in conjunction with endotracheal intubation (ETI). Data on the effects of EGA on target parameters of CSSV are lacking, although EGA are frequently used for initial airway protection during CPR, especially in non-physician-dominated paramedic systems.\u003csup\u003e\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Therefore, the present study compared ventilation parameters during CCSV between ETI and different EGA in a human cadaver model.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This study was approved by the ethics committee of Ruhr University Bochum in Ostwestfalen-Lippe, Bad Oeynhausen, Germany (Chairman: Prof. Dr. Wolfgang Burchert) on February 13, 2024 (Ref. 2024\u0026thinsp;\u0026minus;\u0026thinsp;1183), and was registered at ClinicalTrials.gov (registration number NCT06306898). It was conducted in March and August 2024 at the Institute of Anatomy of Ruhr University Bochum, Germany, Department of Anatomy and Molecular Embryology. This study was reported in accordance with the current CONSORT guidelines.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCadaver Selection and Preparation\u003c/h2\u003e \u003cp\u003eCadavers from adult body donors that were fixed via the Thiel procedure were included. The Thiel procedure was developed by Professor Walter Thiel from Graz, Austria, and first described in 1992.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e This procedure involves intravascular injection and storage of the body donor in a special preservation solution,\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e thus preserving a lifelike anatomical appearance and tissue elasticity.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Such cadavers are often used for training medical procedures and for evaluating respiratory mechanics and dynamic pressures during chest compressions.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: body donors with abnormal airways, a history of tracheostomy, a history of adult respiratory distress syndrome (ARDS), severe lung or thoracic injuries (i.e., pneumothorax), and/or severe aspirations. An external postmortem examination ensured compliance with these criteria.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eETI was performed via direct laryngoscopy (Mallinckrodt tubes; male ID\u0026thinsp;=\u0026thinsp;8.0mm, female ID\u0026thinsp;=\u0026thinsp;7.0mm), followed by bronchoscopy with an Ambu aScope 4 Broncho Slim 2.8 mm \u0026reg; ( Ambu GmbH, Steinkopfstra\u0026szlig;e 4, 61231 Bad Nauheim \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ambu.com\u003c/span\u003e\u003cspan address=\"https://www.ambu.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) to verify the tube position and clear secretions. Lungs were recruited for four minutes via pressure-controlled ventilation with a MEDUMAT Standard\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e ventilator \u0026reg; (WEINMANN Emergency Medical Technology GmbH\u0026thinsp;+\u0026thinsp;Co. KG, Frohb\u0026ouml;sestra\u0026szlig;e 12, 22525 Hamburg, Germany, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.Weinmann-emergency.com\u003c/span\u003e\u003cspan address=\"https://www.Weinmann-emergency.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) (P\u003csub\u003einsp\u003c/sub\u003e=3mbar, PEEP\u0026thinsp;=\u0026thinsp;12mbar, respiratory rate\u0026thinsp;=\u0026thinsp;10/min). After successful recruitment, four different airway devices were applied in a randomized order to perform CCSV: 1. ETI; 2. laryngeal tube\u0026thinsp;=\u0026thinsp;LTSD \u0026reg; (LTS-D, VBM Medizintechnik GmbH, Einsteinstr. 1 72172 Sulz a. N., \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.vbm-medical.de\u003c/span\u003e\u003cspan address=\"https://www.vbm-medical.de\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e); 3. laryngeal mask\u0026thinsp;=\u0026thinsp;LMA \u0026reg; (Ambu AuraGain, Steinkopfstra\u0026szlig;e 4, 61231 Bad Nauheim, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ambu.de\u003c/span\u003e\u003cspan address=\"https://www.ambu.de\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e); and 4. i-Gel laryngeal mask\u0026thinsp;=\u0026thinsp;IGEL \u0026reg; (Intersurgical GmbH, Siegburger Str. 39, 53757 Sankt Augustin, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.intersurgical.com\u003c/span\u003e\u003cspan address=\"https://www.intersurgical.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The size of each EGA was selected based on the manufacturer's guidelines, with the cuff pressure limited to a maximum of 40 mmH\u003csub\u003e2\u003c/sub\u003eO for all airway devices. Each device\u0026rsquo;s position was verified via bronchoscopy, and lung recruitment was repeated with five manual ventilation breaths via a WEINMANN MEDUtrigger before initiating CCSV.\u003c/p\u003e\n\u003ch3\u003eVentilation and Chest Compressions\u003c/h3\u003e\n\u003cp\u003eVentilation was performed with the MEDUMAT Standard\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Ventilator in CCSV mode (pCCSV\u0026thinsp;=\u0026thinsp;40mbar; PEEP\u0026thinsp;=\u0026thinsp;3mbar; respiratory rate (RR)\u0026thinsp;=\u0026thinsp;chest compression rate) for four minutes per device. Chest compressions were performed using the mechanical chest compression device corpuls cpr \u0026reg; (corplus GS Elektromedizinische Ger\u0026auml;te G. Stemple GmbH, Hauswiesenstra\u0026szlig;e 26, 86916 Kaufering, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.corpuls.world/en/pr\u003c/span\u003e\u003cspan address=\"https://www.corpuls.world/en/pr\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) with a compression frequency of 100/min and a pressure depth of 5.5cm.\u003c/p\u003e\n\u003ch3\u003eEndpoints\u003c/h3\u003e\n\u003cp\u003eThe primary endpoint was the achievement of a pCCSV of 40\u0026thinsp;\u0026plusmn;\u0026thinsp;3mbar within the tolerance range specified by the manufacturer. The secondary endpoints included the mean pressure (P\u003csub\u003emean\u003c/sub\u003e) in Millibar (mbar), peak pressure (P\u003csub\u003epeak\u003c/sub\u003e) in mbar, expiratory minute volume (M\u003csub\u003eVe\u003c/sub\u003e) in Liter (l), expiratory tidal volume (V\u003csub\u003ete\u003c/sub\u003e) in Milliliter (ml), leakage volume (V\u003csub\u003eleak\u003c/sub\u003e) in % and respiratory rate (RR).\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eDescriptive analyses were performed first. Continuous variables are expressed as the mean and standard deviation, and categorical variables are expressed as frequencies and proportions. To analyze the primary endpoint, logistic regression analysis with a random intercept was conducted to account for potential within-cadaver correlations. Furthermore, Bland‒Altman analysis was conducted to evaluate the level of agreement between ETI and EGA in terms of the pCCSV.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Additionally, as the manufacturer allows a tolerance range of 37-43mbar for the set pCCSV of 40mbar, we used equivalence tests to determine whether differences in the pCCSV between ETI and EGA fell within the predefined range of -6 to 6. To analyze the secondary outcomes, we used linear mixed regression models with random intercepts. The effect measures for all analyses were odds ratios (OR) or regression coefficients (RC) with 95% confidence intervals (95%CI) and p values (p) if appropriate. A p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered significant. All analyses were performed using the statistical software SAS 9.4\u0026reg; (SAS Institute Inc., Cary, NC).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the twelve cadavers initially assessed for eligibility, eleven were ultimately included in the study. One cadaver was excluded because of a preexisting pneumothorax. Supplement 1 shows the flowchart of the study procedure after all the inclusion and exclusion criteria were applied.\u003c/p\u003e\n\u003ch3\u003eCharacteristic of body donors\u003c/h3\u003e\n\u003cp\u003eTheCharacteristicof included body donors is presented in supplement 2. while Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the descriptive statistics of the measured ventilation parameters across airway devices. Supplementary materials 3\u0026ndash;13 provide detailed information on the ventilation parameters for each individual donor stratified by device.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of the measured ventilation parameters across airway devices.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eETI\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003cp\u003e[mean\u0026plusmn;SD]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEGA\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;131)\u003c/p\u003e \u003cp\u003e[mean\u0026plusmn;SD]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIGEL\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003cp\u003e[mean\u0026plusmn;SD]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLMA\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e \u003cp\u003e[mean\u0026plusmn;SD]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLTSD\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;44)\u003c/p\u003e \u003cp\u003e[mean\u0026plusmn;SD]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003epressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.3\u0026plusmn;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.3\u0026plusmn;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.5\u0026plusmn;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.9\u0026plusmn;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.6\u0026plusmn;4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.2\u0026plusmn;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4\u0026plusmn;23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.7\u0026plusmn;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.1\u0026plusmn;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.4\u0026plusmn;3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.7\u0026plusmn;7.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.2\u0026plusmn;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.1\u0026plusmn;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.6\u0026plusmn;4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.1\u0026plusmn;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u0026plusmn;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.8\u0026plusmn; 4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.82\u0026plusmn;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.8\u0026plusmn;3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98.0\u0026plusmn;42.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.7\u0026plusmn;43.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.7\u0026plusmn;47.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.7\u0026plusmn;40.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.3\u0026plusmn;40.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.4\u0026plusmn;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.4\u0026plusmn;33.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.7\u0026plusmn;31.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.1\u0026plusmn;26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.8\u0026plusmn;34.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory Rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.3\u0026plusmn;14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.9\u0026plusmn;31.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.8\u0026plusmn;30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62.7\u0026plusmn;34.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79.9\u0026plusmn;28.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eLegend: \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003eETI-Endotracheal Intubation; \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003eEGA-Extraglottic Airway Device; \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003eIGE-Igel Laryngeal mask; \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003eLMA-Laryngeal Mask; \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003eLTSD-Laryngeal Tube; \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003eCCSV-Chest-Compression-Synchronized-Ventilation;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eVentilation Performance Comparison\u003c/h3\u003e\n\u003cp\u003eWhen comparing ETI to EGA, the Chance of achieving the target pCCSV range was lower when using the EGA than when using ETI: IGEL (OR\u0026thinsp;=\u0026thinsp;0.82; 95%CI\u0026thinsp;=\u0026thinsp;0.34-2.00; p\u0026thinsp;=\u0026thinsp;0.0256); LMA (OR\u0026thinsp;=\u0026thinsp;0.25; 95%CI\u0026thinsp;=\u0026thinsp;0.10\u0026ndash;0.63; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001); and LTSD (OR\u0026thinsp;=\u0026thinsp;0.68; 95%CI\u0026thinsp;=\u0026thinsp;0.28\u0026ndash;1.62; p\u0026thinsp;=\u0026thinsp;0.00012). When comparing the individual EGA, LMA demonstrated a significantly lower chance of achieving the target pCCSV than IGEL (OR\u0026thinsp;=\u0026thinsp;0.29; 95%CI\u0026thinsp;=\u0026thinsp;0.11\u0026ndash;0.75; p\u0026thinsp;=\u0026thinsp;0.0111) and LTSD (OR\u0026thinsp;=\u0026thinsp;0.358; 95%CI\u0026thinsp;=\u0026thinsp;0.140\u0026ndash;0.971; p\u0026thinsp;=\u0026thinsp;0.0326). No significant difference in the chance of achieving the target pCCSV was observed between LTSD and IGEL (OR\u0026thinsp;=\u0026thinsp;0.81; 95%CI\u0026thinsp;=\u0026thinsp;0.33-2.00; 0.6513). EGA had a lower V\u003csub\u003ete\u003c/sub\u003e (RC\u0026thinsp;=\u0026thinsp;42.42; 95%CI\u0026thinsp;=\u0026thinsp;32.07\u0026ndash;52.77; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001); and a higher V\u003csub\u003eleak\u003c/sub\u003e(RC=-55.03; 95%CI=-62.92\u0026ndash;47.15; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Chest Compression Synchronized Ventilation Pressures\u003c/h2\u003e \u003cp\u003eThe comparison between ETI and EGA revealed that ETI yielded greater pCCSV (RC\u0026thinsp;=\u0026thinsp;2.99; 95%CI\u0026thinsp;=\u0026thinsp;1.63\u0026ndash;4.35; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than the EGA. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the results of the linear mixed models with random intercepts for the different ventilation parameters when comparing ETI and the EGA. Comparisons of the individual EGA and ETI revealed a lower pCCSV for each individual EGA than for ETI (IGEL vs. ETI RC=-1.85; 95%CI=-3.48\u0026ndash;0.23; p\u0026thinsp;=\u0026thinsp;0.0256; LMA vs. ETI RC=-4.45; 95%CI=-6.08\u0026ndash;2.81; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; LTSD vs. ETI RC=-2.71; 95%CI=-4.33\u0026ndash;1.09; p\u0026thinsp;=\u0026thinsp;0.0012). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the results of the linear mixed models with random intercepts for the different ventilation parameters when comparing each individual EGA with ETI.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of linear mixed models with random intercept for the various ventilation parameters in the comparison of endotracheal intubation vs. extraglottic airway devices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegression coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003epressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.63\u0026ndash;4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.85\u0026ndash;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.80\u0026ndash;7.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.04\u0026ndash;4.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.07\u0026ndash;52.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-55.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-62.92\u0026ndash;47.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.28\u0026ndash;24.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLegend\u003c/b\u003e: \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003eCCSV-Chest-Compression-Synchronized-Ventilation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of linear mixed models with random intercept for the various ventilation parameters in the comparison of the individual extraglottic airway devices vs. endotracheal intubation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegression coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eIGEL\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e vs. ETI\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003epressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.48\u0026ndash;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.55\u0026ndash;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-6.56\u0026ndash;2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.45\u0026ndash;2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-20.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-45.43\u0026ndash;21.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.72\u0026ndash;53.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-11.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-21.01\u0026ndash;1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLMA\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003evs. ETI\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV pressure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-6.08\u0026ndash;2.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.17\u0026ndash;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-6.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-8.72\u0026ndash;4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-6.48\u0026ndash;4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-56.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-68.85\u0026ndash;44.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.06\u0026ndash;80.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-27.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-37.15\u0026ndash;17.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLTSD\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003evs. ETI\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003epressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.33\u0026ndash;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.83\u0026ndash;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak Pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-7.10\u0026ndash;3.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.51\u0026ndash;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-37.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-49.86\u0026ndash;25.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.78\u0026ndash;57.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-10.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-19.94\u0026ndash;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0327\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eLegend: \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003eIGEL-Igel Laryngeal mask; \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003eETI-Endotracheal Intubation; \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003eCCSV-Chest-Compression-Synchronized-Ventilation; \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003eLMA-Laryngeal Mask; \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003eLTSD-Laryngeal Tube\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the Bland‒Altman plot comparing pCCSV values between ETI and the individual EGA. The findings demonstrated a moderate level of agreement, with some observations falling outside the limits of agreement. The highest level of agreement was observed between LTSD and ETI. Equivalence tests revealed evidence of equivalence between ETI and the EGA within the predefined equivalence range of -6 to 6 except for the comparison of LMA and ETI (p\u0026thinsp;=\u0026thinsp;0.0946). Statistically significant p values were observed for the following comparisons: ETI vs. overall EGA (p\u0026thinsp;=\u0026thinsp;0.0217), IGEL vs. ETI (p\u0026thinsp;=\u0026thinsp;0.0055), and LTSD vs. ETI (p\u0026thinsp;=\u0026thinsp;0.0406).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComparisons between Extraglottic Airway Devices\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the results of the linear mixed model with random intercepts for the 7 different ventilation parameters (pCCSV; P\u003csub\u003emean\u003c/sub\u003e; P\u003csub\u003epeak\u003c/sub\u003e; M\u003csub\u003eVe\u003c/sub\u003e; V\u003csub\u003ete\u003c/sub\u003e; V\u003csub\u003eleak\u003c/sub\u003e; RR) when conducting comparison between the individual EGA. Lower pCCSV values were observed when comparing LMA and IGEL (RC=-2.58; 95%CI=-4.04\u0026ndash;1.13; p\u0026thinsp;=\u0026thinsp;0.0006), LMA and LTSD (RC=-1.73; 95%CI=-3.18\u0026ndash;0.27; p\u0026thinsp;=\u0026thinsp;0.0204) and LTSD and IGEL (RC=-0.86; 95%CI=-2.30-0.59; p\u0026thinsp;=\u0026thinsp;0.2434).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eResults of linear mixed models with random intercept for the various ventilation parameters in the comparison of the individual extraglottic airway devices against each other\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegression coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eLMA\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e vs. IGEL\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003epressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-4.04\u0026ndash;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.66-0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1957\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.65\u0026ndash;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.10\u0026ndash;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-23.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-35.48\u0026ndash;11.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.89\u0026ndash;34.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-16.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-25.95\u0026ndash;6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLTSD\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003evs. IGEL\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003epressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.30-0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.28-0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5694\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.97-0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.12-1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-16.41-7.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4650\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-5.38-11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-8.74-10.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLMA\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003evs. LTSD\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCCSV\u003c/b\u003e\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e \u003cb\u003epressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.18\u0026ndash;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.37\u0026ndash;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePeak pressure\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(mbar)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.11\u0026ndash;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory minute volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(l)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.04\u0026ndash;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExpiratory tidal volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-18.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-31.05\u0026ndash;6.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeakage volume\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.83\u0026ndash;31.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRespiratory rate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-17.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-27.01\u0026ndash;7.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eLegend: \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003eLMA-Laryngeal Mask; \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003eIGEL-Igel Laryngeal mask; \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003eCCSV-Chest-Compression-Synchronized-Ventilation; \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003eLTSD-Laryngeal Tube\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective, randomized study of human cadaver models compared key ventilation parameters detected during CCSV between different EGA and ETI. The EGA were associated with a lower chance of achieving the target pCCSV range than ETI. However, the results revealed evidence of equivalence in pCCSV between EGA (especially IGEL and LTSD) and ETI, with a moderate level of agreement. On the other hand, the EGAs had a lower likelihood of achieving the target pCCSV range, a lower V\u003csub\u003ete\u003c/sub\u003e and a higher V\u003csub\u003eleak\u003c/sub\u003e.\u003c/p\u003e \u003cp\u003eThe optimal airway management during CPR has been the subject of debate in recent decades. While ETI is widely considered to be the gold standard airway management technique,\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e it is often more technically challenging, typically requires advanced practitioner expertise.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Extraglottic airway devices such as the LTSD can be used for patients with cardiac arrest during both basic and advanced life support. In contrast, EGA are commonly used internationally in non-physician-based emergency medical services.\u003csup\u003e\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Since few studies have evaluated the influence of EGA on CCSV are still lacking, the present study examined this topic using a human cadaver model with the aim of providing unique insights into the feasibility of CCSV with different EGA.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRole of the Chest Compression Synchronized Ventilation pressure\u003c/h2\u003e \u003cp\u003eThe primary goal of IRV is to ensure adequate oxygenation and decarboxylation of the blood to prevent hypercapnia and respiratory acidosis with the lowest level of hemodynamic compromise. The inspiratory stroke applied by the pCCSV synchronized with chest compression prevents the loss of intrathoracic pressure via the airway device, thereby increasing the intrathoracic volume and generating a mean expiratory pressure of approximately 10mbar.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e These mechanisms may explain the favorable effects of CCSV on oxygenation, decarboxylation, cerebral oxygenation and cardiac output that have been observed in animal studies.\u003csup\u003e\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e An essential prerequisite for these physiological ventilatory effects in CCSV is the reliable application of the set pCCSV with the lowest possible V\u003csub\u003eleak\u003c/sub\u003e while triggering every chest compression effectively. In this study, evidence of equivalence between EGA and ETI was observed for the target range of pCCSV. Among the EGA examined herein, the IGEL and the LTSD appeared to be particularly suitable for CCSV.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRole of the leakage volume\u003c/h2\u003e \u003cp\u003eThe air leaks during the use of EGA has been extensively studied in anesthesiology, typically showing no clinically relevant effects on ventilation feasibility, as long as the applied V\u003csub\u003et\u003c/sub\u003e ensures adequate alveolar ventilation and avoids critical gastric insufflation or regurgitation.\u003csup\u003e\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e IRV generates significantly higher intrathoracic pressures due to chest compressions. These elevated pressures can impact both V\u003csub\u003et\u003c/sub\u003e delivery and V\u003csub\u003eleak\u003c/sub\u003e when EGA are used, regardless of the ventilation mode.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Therefore, relevant V\u003csub\u003eleak\u003c/sub\u003e may reduce the potentially favorable effects on oxygenation, ventilation, and hemodynamics due to the physiological effects of CCSV. In the present study, V\u003csub\u003eleak\u003c/sub\u003e was observed for all airway devices used, including ETI, with significant V\u003csub\u003eleak\u003c/sub\u003e occurring for EGA. These V\u003csub\u003eleak\u003c/sub\u003e values could explain the lower V\u003csub\u003ete\u003c/sub\u003e and lower RR observed in the present study, which may have been due to insufficient triggering in the EGA.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eIndividualized ventilation strategy for cardiac arrest\u003c/h2\u003e \u003cp\u003eWhile cardiac arrest is an extremely heterogeneous event that results from various underlying comorbidities, CPR according to guidelines represents a rather uniform, highly standardized therapy.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Recent advances, such as echocardiography-guided optimization of the compression point and depth as well as the level of adrenaline dosing, have highlighted the potential of individualized CPR to improve patient outcomes.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e However, individualization is not yet incorporated into the guidelines for IRV.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eInterestingly, in this study, some body donors easily achieved the target pCCSV with various EGA, yielding V\u003csub\u003ete\u003c/sub\u003e values comparable to those of ETI, whereas others exhibited insufficient ventilation even with ETI (see Supplement 3\u0026ndash;13). The results provide unique insights into the effects of different airway devices on ventilation parameters during CCSV. These findings suggest that CCSV may be feasible in the context of individualized CPR when EGA are used to achieve ventilation therapy targets. This finding highlights the need for individualized consideration of ventilation parameters during CPR. Similar to the routine re-evaluation of heart rhythm, regular reassessment of ventilation parameters is essential to optimize resuscitation outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe limitations of this study include the small sample size (i.e., eleven body donors); thus, this study could be underpowered, thereby limiting the generalizability of the findings. Second, the impact of Thiel fixation on the tissues of body donors could differ from the physiological responses in living resuscitation patients. However, Thiel fixation is widely used for similar studies.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e As this study was conducted on human body donors, it was possible to assess respiratory pressure and respiratory mechanics; however, functional parameters such as paO\u003csub\u003e2\u003c/sub\u003e, paCO\u003csub\u003e2\u003c/sub\u003e, cerebral oxygenation and arterial blood pressure could not be measured. Despite this limitation, however, this study is the first to provide unique insights into the effects of different airway adjuncts during IRV with CCSV in a randomized and controlled human cadaver model.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe likelihood of achieving the target pCCSV range were lower when using the EGA than when using ETI. While the EGA demonstrated comparable performance to ETI in terms of achieving the target pCCSV, the EGA were associated with a lower V\u003csub\u003ete\u003c/sub\u003e and higher V\u003csub\u003eleak\u003c/sub\u003e. Future studies should explore these outcomes across diverse populations and clinical settings, assessing how individualized IRV can be optimized with EGA.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eDisclosures:\u003c/h2\u003e \u003cp\u003eM. Darvishali, V. Kuehn and C. Neuhaus are salaried employees of WEINMANN Emergency Medical Technology. The other authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eThe authors would like to thank the company VBM Medizintechnik GmbH for providing laryngeal tubes, as well as the company corpuls GS Elektromedizinische Ger\u0026auml;te G. Stemple GmbH for the loan of a corpuls cpr mechanical resuscitation device. We would also like to thank Mr. Dieter Langelahn for providing technical support.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSources of Funding\u003c/b\u003e: This study was funded by WEINMANN Emergency Medical Technology GmbH\u0026thinsp;+\u0026thinsp;Co. KG, Frohb\u0026ouml;sestra\u0026szlig;e 12, 22525 Hamburg, Germany, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.Weinmann-emergency.com\u003c/span\u003e\u003cspan address=\"https://www.Weinmann-emergency.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYan S, Gan Y, Jiang N, Wang R, Chen Y, Lou Z, Zong Q, Chen S. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis.  Crit Care. 2020;24(1):61. DOI:10.1186/s13054-020-2773-2 \u003c/li\u003e\n\u003cli\u003eMyat A, Song KJ, Rea T. 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DOI:10.1097/MEJ.0000000000000230\u003c/li\u003e\n\u003cli\u003eAndersen LW, Granfeldt A. Pragmatic Airway Management in Out-of-Hospital Cardiac Arrest. JAMA. 2018;320(8):761-763. doi:10.1001/jama.2018.10824. DOI:10.1001/jama.2018.10824\u003c/li\u003e\n\u003cli\u003eNeth MR, Idris A, McMullan J, Benoit JL, Daya MR. A review of ventilation in adult out-of-hospital cardiac arrest. J Am Coll Emerg Physicians Open. 2020;1(3):190-201. DOI:10.1002/emp2.12065\u003c/li\u003e\n\u003cli\u003eQamarul Hoda M, Samad K, Ullah H. ProSeal versus Classic laryngeal mask airway (LMA) for positive pressure ventilation in adults undergoing elective surgery. Cochrane Database Syst Rev.2017;7(7):CD009026. DOI:10.1002/14651858.CD009026.pub2\u003c/li\u003e\n\u003cli\u003eKim MS, Park JH, Lee KY, Choi SH, Jung HH, Kim JH, Lee B. Influence of head and neck position on the performance of supraglottic airway devices: A systematic review and meta-analysis. PLoS One. 2019;14(5):e0216673. DOI:10.1371/journal.pone.0216673\u003c/li\u003e\n\u003cli\u003eGenzw\u0026uuml;rker H, Finteis T, Hinkelbein J, Ellinger K. Erste klinische Erfahrungen mit dem neuen LTS. Ein Larynx-Tubus mit \u0026ouml;sophagealer Drainagem\u0026ouml;glichkeit [First clinical experiences with the new LTS. A laryngeal tube with an oesophageal drain]. Anaesthesist. 2003;52(8):697-702. DOI:10.1007/s00101-003-0539-2\u003c/li\u003e\n\u003cli\u003eGenzwuerker HV, Hinkelbein J. Esophageal seal is not the only consideration in supraglottic airway devices. Anesth Analg. 2008;107(1):344-5. DOI:10.1213/ane.0b013e3181784bda\u003c/li\u003e\n\u003cli\u003eVanwulpen M, Wolfskeil M, Duchatelet C, Hachimi-Idrissi S. Do manual chest compressions provide substantial ventilation during prehospital cardiopulmonary resuscitation? Am J Emerg Med. 2021;39:129-131. DOI:10.1016/j.ajem.2020.09.037\u003c/li\u003e\n\u003cli\u003eUllmann H, Renziehausen L, Geil D, Sponholz C, Thomas-R\u0026uuml;ddel D, V\u0026ouml;lker MT, Pietsch U, Krug N, Bercker S. The Influence of Positive End-Expiratory Pressure on Leakage and Oxygenation Using a Laryngeal Mask Airway: A Randomized Trial. Anesth Analg. 2022;135(4):769-776. DOI:10.1213/ANE.0000000000006115\u003c/li\u003e\n\u003cli\u003eBerg RA, Hemphill R, Abella BS, Aufderheide TP, Cave DM, Hazinski MF, et al. Part 5 adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S685‐705. DOI:10.1161/CIRCULATIONAHA.110.970939\u003c/li\u003e\n\u003cli\u003eHuang Y, He Q, Yang LJ, Liu GJ, Jones A. Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest. Cochrane Database Syst Rev. 2014;2014(9):CD009803. DOI:10.1002/14651858.CD009803.pub2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chest Compression Synchronized Ventilation, Extragloztic airway devices, Cardiopulmonary resuscitation, Endotracheal Intubation, Intra-arrest ventilation","lastPublishedDoi":"10.21203/rs.3.rs-6272494/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6272494/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChest Compression Synchronized Ventilation (CCSV) is a new ventilation mode designed to improve both ventilation and cardiac output during cardio-pulmonary resuscitation. So far, the use of CCSV with extraglottic airway devices (EGA) is scarcely investigated. This study evaluates the effectiveness of EGA compared to endotracheal Intubation (ETI) for ventilation parameters during CCSV in continuous resuscitation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe lungs of Thiel-embalmed cadavers of adult body donors were initially ventilated using ETI and bronchoscopy. Subsequently, various EGA (Laryngeal Mask, Laryngeal Tube, iGel Laryngeal Mask) and ETI were applied in randomized order during continuous chest compressions using corpuls-cpr. CCSV was applied with a pCCSV\u0026thinsp;=\u0026thinsp;40 mbar, PEEP\u0026thinsp;=\u0026thinsp;3 mbar, respiratory rate\u0026thinsp;=\u0026thinsp;chest compression rate. The primary endpoint was achieving a target CCSV pressure (pCCSV) of 40\u0026thinsp;\u0026plusmn;\u0026thinsp;3 mbar. Secondary endpoints included pCCSV, expiratory tidal volumes (V\u003csub\u003ete\u003c/sub\u003e) and leakage volumes (V\u003csub\u003eleak\u003c/sub\u003e).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEleven cadavers were included. The mean pCCSV was 41.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 mbar for ETI and 38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1 mbar for EGA. Mean V\u003csub\u003ete\u003c/sub\u003e was 98.0\u0026thinsp;\u0026plusmn;\u0026thinsp;42.4 ml for endotracheal intubation as compared to 55.7\u0026thinsp;\u0026plusmn;\u0026thinsp;43.5 ml for extraglottic airway devices. Mean V\u003csub\u003eleak\u003c/sub\u003e for endotracheal intubation was 5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7% compared to 60.4\u0026thinsp;\u0026plusmn;\u0026thinsp;33.0% for EGA. Endotracheal intubation showed higher chances of reaching the pCCSV target, along with higher V\u003csub\u003ete\u003c/sub\u003e and lower leakage volumes\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWhile extraglottic airway devices demonstrated comparable performance to ETI for achieving pCCSV, EGA were associated with a lower likelihood of reaching the target pCCSV range, lower V\u003csub\u003ete\u003c/sub\u003e, and higher V\u003csub\u003eleak\u003c/sub\u003e. Further studies are warranted to evaluate the clinical implications of these findings.\u003c/p\u003e\u003ch2\u003eRegistration:\u003c/h2\u003e \u003cp\u003eURL: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.clinicaltrials.gov\u003c/span\u003e\u003cspan address=\"https://www.clinicaltrials.gov\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; Unique identifier: number NCT06306898\u003c/p\u003e","manuscriptTitle":"Effectiveness of extraglottic airway device in Chest Compression Synchronized Ventilation during continuous resuscitation: A prospective randomized cadaver study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-11 10:53:21","doi":"10.21203/rs.3.rs-6272494/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52580081-38fb-445b-81b5-9ef079d68b56","owner":[],"postedDate":"April 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-17T06:40:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-11 10:53:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6272494","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6272494","identity":"rs-6272494","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}