Does Airway Type Affect Tidal Volume During Chest Compressions? New Insights from a Neonatal Animal Model
- georgschmoelzer
- Jul 27
- 2 min read
Tidal volume delivery during chest compression with either an endotracheal tube or supraglottic airway in a porcine animal model
The 2023 Consensus on Science and Treatment Recommendations supports the use of supraglottic airways (SGAs) as an alternative to endotracheal intubation during neonatal resuscitation. However, one key question remains unanswered:
Can SGAs deliver effective tidal volumes (VT) during chest compressions?
Our recent randomized crossover study in a neonatal piglet model set out to address this critical knowledge gap.
Study Design at a GlanceSeven neonatal piglets (1–3 days old) were euthanized to eliminate confounding from spontaneous breathing. Each piglet underwent a series of resuscitation scenarios using:
Two airway types: Endotracheal tube (ETT) vs. Supraglottic airway (SGA)
Two chest compression techniques:
Continuous chest compressions with sustained inflations (CC + SI)
3:1 compression-to-ventilation ratio (3:1 C:V)
Four ventilation devices: T-piece, flow-inflating bag (FIB), self-inflating bag (SIB), and the NextStep™ resuscitator
Each combination was tested in 1-minute trials, and tidal volume and respiratory parameters were continuously recorded.
Key Findings
ETT + CC + SI consistently resulted in tidal volume gain, regardless of the ventilation device used.
Both ETT and SGA with 3:1 C:V resulted in tidal volume loss across all ventilation devices.
Significant leak was observed with the SGA during chest compressions, limiting its effectiveness for delivering adequate tidal volumes.
What Does This Mean for Neonatal Resuscitation?
✅ What we knew: SGAs are increasingly used in delivery rooms as an alternative to intubation.
❗ What we’ve learned:
During chest compressions, SGAs may not be as effective in delivering adequate tidal volumes due to substantial leak.
The CC + SI technique, when paired with ETT, provides superior VT delivery, making it a potentially better option during neonatal CPR.
Clinical ImplicationsThis study underscores the importance of airway choice and compression strategy in optimizing ventilation during neonatal resuscitation. While SGAs remain a valuable tool, their limitations—especially under chest compression—should be carefully considered. When feasible, early intubation and use of CC + SI may enhance ventilation effectiveness and support better outcomes.
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