Resuscitation. 2025 Dec 4:110918. doi: 10.1016/j.resuscitation.2025.110918. Online ahead of print.

INTRODUCTION: This study examines the influence of supraglottic airway (SGA) devices versus tracheal intubation (TI) on key ventilation parameters during intra-arrest-ventilation using volume-controlled-ventilation (VCV) in adult out-of-hospital cardiac arrest (OHCA).

METHODS: This cohort study is based on real-world data obtained from the emergency medical service of the Gütersloh district, Germany. Ventilation data were extracted in March 2024 from emergency ventilators and combined with patient-level information from the German Resuscitation Registry. Adult OHCA cases receiving intra-arrest-ventilation 01/2019-08/2023 with VCV via either SGA or TI were included. Collected parameters included the airway device used, set tidal volume (VTset), measured expiratory tidal volume (VTe), and leakage volume (VLeak). The primary outcome was the difference between VTset-VTe. Patients were grouped according to the airway management strategy used (SGA vs. TI). Potential differences in outcomes between these groups were assessed using linear mixed regression models.

RESULTS: VCV was performed in n=27 individuals (682 minutes) using SGA in n=13 (330 minutes) vs. TI in n=14 (352 minutes). The mean total VTset was 562.8±58.0ml (TI=573.9±62.5ml; SGA=550.9±50.1ml). The mean VTe totaled 270.7±205.5ml (TI=348.1±215.6ml; SGA=188.2±156.6ml). The mean VLeak was 23.3±27.4% (TI=5.5±7.0%; SGA=42.3±28.4%). Compared to SGA, TI was associated with smaller VTset-VTe (regression coefficient: -128.3ml; 95%-CI: [-252.3ml; -4.3ml]; p=0.0427) as well as for a lower VLeak (regression coefficient: -32.3%; 95%-CI: [-46.1%; -18.4%]; p<0.0001) for TI.

CONCLUSION: In OHCA cases receiving mechanical intra-arrest-ventilation with VCV, TI was associated with higher delivered VTe, less deviation from VTset, and significantly lower VLeak compared to SGA.

PubMed:41352474 | DOI:10.1016/j.resuscitation.2025.110918