title: Evaluation of six different airway devices regarding regurgitation and pulmonary aspiration during cardio-pulmonary resuscitation (CPR) - A human cadaver pilot study.
abstract: BACKGROUND
  Chest compressions and ventilation are lifesaving tasks during cardio-pulmonary resuscitation (CPR). Besides oxygenation, endotracheal intubation (ETI) during CPR is performed to avoid aspiration of gastric contents. If intubation is difficult or impossible, supraglottic airway devices are utilized. We tested six different airway devices regarding their potential to protect against regurgitation and aspiration during CPR in a randomized experimental human cadaver study.
  
  
  METHODS
  Five-hundred ml of 0.01% methylene-blue-solution were instilled into the stomach of 30 adult human cadavers via an oro-gastric tube. The cadavers were then randomly assigned to one of six groups, resulting in 5 cadavers in each group. Airway management was performed with either bag-valve ventilation, Laryngeal Tube, EasyTube, Laryngeal Mask (Classic), I-Gel, or ETI. Thereafter 5min of CPR were performed according to the 2010 Guidelines of the European Resuscitation Council. Pulmonary aspiration was defined as the presence of methylene-blue-solution below the vocal cords or the ETI cuff as assessed by fiber-optic bronchoscopy.
  
  
  RESULTS
  Thirty cadavers were included (14 females, 16 males). Aspiration was detected in three out of five cadavers receiving bag-valve ventilation and in two out of five intubated with LMA or I-Gel. In cadavers intubated with the LT, aspiration occurred in one out of five cases. No aspiration could be detected in cadavers intubated with ETI and EasyTube.
  
  
  CONCLUSIONS
  This study provides experimental evidence that, during CPR, ETI offers superior protection against regurgitation and pulmonary aspiration of gastric contents than supraglottic airway devices or bag-valve ventilation.
authors.affiliation: Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Piegeler
authors.affiliation: Medical Simulation and Emergency Management Research Group, Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Bernard
authors.initials: B
authors.lastname: Roessler
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.affiliation: Federal Ministry of the Interior, Medical Department, Vienna, Austria.
authors.forename: Henrik
authors.initials: H
authors.lastname: Fischer
authors.affiliation: Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; Institute of Physiology, University Zurich, Zurich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Schlaepfer
authors.affiliation: Institute of Pathology, Medical University Vienna, Vienna, Austria.
authors.forename: Susanna
authors.initials: S
authors.lastname: Lang
authors.affiliation: Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, The Cleveland Clinic, Cleveland, USA. Electronic address: KR@or.org.
authors.forename: Kurt
authors.initials: K
authors.lastname: Ruetzler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000295:instrumentation*; D002102:Cadaver; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D017214:Laryngeal Masks; D057045:Laryngopharyngeal Reflux / Q000517:prevention & control*; D008297:Male; D008348:Manikins; D008875:Middle Aged; D010865:Pilot Projects; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000295:instrumentation*
keywords: Airway management; Cardio Pulmonary Resuscitation (CPR); Pulmonary aspiration