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

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

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

10.21203/rs.3.rs-778473/v1 ◽

2021 ◽

Author(s):

Loric Stuby ◽

Laurent Jampen ◽

Julien Sierro ◽

Maxime Bergeron ◽

Erik Paus ◽

...

Keyword(s):

Primary Outcome ◽

Controlled Trial ◽

Face Mask ◽

Airway Device ◽

Supraglottic Airway ◽

Chest Compressions ◽

Randomized Controlled ◽

The Difference ◽

Hospital Cardiac Arrest

Abstract Early insertion of a supraglottic airway (SGA) device could improve CCF by allowing providers to perform continuous chest compressions or by shortening the interruptions needed to deliver ventilations. SGA devices do not require the same expertise as endotracheal intubation. This study aimed to determine whether the immediate insertion of an i-gel® while providing continuous chest compressions with asynchronous ventilations could generate higher CCFs than the standard 30:2 approach using a face-mask in a simulation of OHCA. A multicenter, parallel, randomised, superiority, simulation study was carried out. The primary outcome was the difference in CCF during the first two minutes of resuscitation. Overall and per-cycle CCF, quality of compressions and ventilations parameters were also compared. Among 13 teams of two participants, the early insertion of an i-gel® resulted in higher CCFs during the first two minutes (89.0% vs 83.6%, p=0.001). Overall and per-cycle CCF were consistently higher in the i-gel® group, even after the 30:2 alternation had been resumed. In this group, ventilation parameters were enhanced, but compressions were significantly shallower (4.6 cm vs 5.2 cm, p=0.007). This latter issue must be addressed before clinical trials can be considered.Trial registration: NCT04736446 (03/02/2021)

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Design and implementation of the AIRWAYS-2 trial: A multi-centre cluster randomised controlled trial of the clinical and cost effectiveness of the i-gel supraglottic airway device versus tracheal intubation in the initial airway management of out of hospital cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2016.09.016 ◽

2016 ◽

Vol 109 ◽

pp. 25-32 ◽

Cited By ~ 24

Author(s):

Jodi Taylor ◽

Sarah Black ◽

Stephen J. Brett ◽

Kim Kirby ◽

Jerry P. Nolan ◽

...

Keyword(s):

Cardiac Arrest ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Airway Device ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Design And Implementation ◽

Cluster Randomised ◽

Randomised Controlled ◽

Hospital Cardiac Arrest

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Cost-effectiveness of the i-gel Supraglottic Airway Device compared to Tracheal Intubation During Out-of-Hospital Cardiac Arrest: Findings from the AIRWAYS-2 Randomised Controlled Trial

Resuscitation ◽

10.1016/j.resuscitation.2021.06.002 ◽

2021 ◽

Author(s):

Elizabeth A. Stokes ◽

Michelle J. Lazaroo ◽

Madeleine Clout ◽

Stephen J. Brett ◽

Sarah Black ◽

...

Keyword(s):

Cardiac Arrest ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Tracheal Intubation ◽

Controlled Trial ◽

Airway Device ◽

Supraglottic Airway ◽

Supraglottic Airway Device ◽

Randomised Controlled ◽

Hospital Cardiac Arrest

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Mechanical chest compression device use in patients in a non-shockable rhythm at in-hospital cardiac arrest: a multi-centre feasibility randomised controlled trial (COMPRESS-RCT)

Resuscitation ◽

10.1016/j.resuscitation.2019.06.089 ◽

2019 ◽

Vol 142 ◽

pp. e36

Author(s):

Keith Couper ◽

Tom Quinn ◽

Katie Booth ◽

Anne Devrell ◽

Ranjit Lall ◽

...

Keyword(s):

Cardiac Arrest ◽

Randomised Controlled Trial ◽

Chest Compression ◽

Controlled Trial ◽

Compression Device ◽

Shockable Rhythm ◽

Feasibility Randomised Controlled Trial ◽

Device Use ◽

Randomised Controlled ◽

Hospital Cardiac Arrest

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Higher insertion success with the i-gel® supraglottic airway in out-of-hospital cardiac arrest: A randomised controlled trial

Resuscitation ◽

10.1016/j.resuscitation.2014.02.021 ◽

2014 ◽

Vol 85 (7) ◽

pp. 893-897 ◽

Cited By ~ 16

Author(s):

Paul MacConachie Middleton ◽

Paul Michael Simpson ◽

Richard E. Thomas ◽

Jason Charles Bendall

Keyword(s):

Cardiac Arrest ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Supraglottic Airway ◽

Randomised Controlled ◽

Hospital Cardiac Arrest

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Effect on Chest Compression Fraction of Continuous Manual Compressions with Asynchronous Ventilations Using an i-gel® versus 30:2 Approach during Simulated Out-of-Hospital Cardiac Arrest: Protocol for a Manikin Multicenter Randomized Controlled Trial

Healthcare ◽

10.3390/healthcare9030354 ◽

2021 ◽

Vol 9 (3) ◽

pp. 354

Author(s):

Loric Stuby ◽

Laurent Jampen ◽

Julien Sierro ◽

Erik Paus ◽

Thierry Spichiger ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Airway Management ◽

Chest Compression ◽

User Satisfaction ◽

Controlled Trial ◽

Face Mask ◽

Spontaneous Circulation ◽

Multicenter Randomized Controlled Trial ◽

Hospital Cardiac Arrest

The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. This is a protocol for a multicenter, parallel, randomized simulation study. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel® supraglottic device to deliver asynchronous ventilations). The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers’ self-assessed cognitive load.

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