Optimizing Airway Management in Cardiac Arrest: Key Insights from a Cadaver Study

A cadaver study found that airway device choice produced measurable differences in intra-arrest ventilation; tracheal intubation yielded more consistent tidal volumes and less airway leak than supraglottic devices.

In ED resuscitation, delivered minute ventilation and airway leak alter gas exchange and intrathoracic pressures during CPR.

ED teams commonly use bag-valve ventilation with either tracheal tubes or supraglottic airways; device selection alters tidal-volume delivery and leak. Comparative performance during chest compressions has been uncertain, leaving limited evidence to guide device choice—particularly regarding tidal-volume variability and leakage during manual bag-valve ventilation. Linking device performance to potential outcome relevance underscores why these ventilation parameters matter clinically.

The randomized human cadaver model tested manual bag-valve ventilation during ongoing chest compressions, comparing an endotracheal tube with multiple supraglottic devices. Investigators measured inspiratory and expiratory tidal volumes, ΔVt (difference between target and expiratory Vt), and leak volume as primary endpoints. Endotracheal tube ventilation showed smaller tidal-volume variability and lower leak versus supraglottic devices, resulting in higher delivered minute ventilation under the study conditions—favoring tracheal intubation for more consistent intra-arrest ventilation.

The findings highlight a clear trade-off: supraglottic devices can be faster to place, while tracheal tubes provided more consistent tidal volumes and less leak. Rapid confirmation of tube position and disciplined bag-valve technique are required to realize that consistency. Teams must weigh time to secure the airway, operator skill, and the potential for interrupted compressions when choosing strategy during cardiac arrest.

From a systems perspective, these results support protocol review focused on ventilation adequacy and leak reduction. Consider favoring tracheal intubation when trained personnel and circumstances permit, introduce targeted bag-valve technique training, and prospectively audit device performance and ventilation metrics to assess real-world impact.

Key Takeaways:

• Tracheal intubation produced lower tidal-volume variability and less airway leak than supraglottic devices in a randomized cadaver model.
• Device choice and disciplined bag-valve technique materially affect delivered minute ventilation and should inform ED airway strategy.
• EDs should consider protocol updates, targeted training, and prospective audits of ventilation metrics to ensure intra-arrest ventilation adequacy.