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Background:Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation.Methods:The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression.Results:Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35–49), compared with Air-Q (21 seconds, 18–32) and I-Gel (19 seconds, 17–27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001).Conclusions:Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.

Endotracheal intubation is the gold standard for airway management. Supraglottic airway devices (SADs) are useful in airway abnormalities. SAD blind intubation enables airway management with better ventilation and a reduced risk of gastric content aspiration. The aim was to compare various SADs in blind intubation performed by inexperienced physicians in several pediatric airway scenarios. One hundred sixteen physicians with no previous experience with SAD performed blind endotracheal intubations with (1) iGEL, (2) Air-Q intubating laryngeal airway, and (3) Ambu AuraGain disposable laryngeal mask in a pediatric manikin in three airway scenarios: (A) normal airway without chest compressions, (B) normal airway with continuous chest compressions with the CORPULS CPR system, and (C) difficult airway with continuous chest compressions with the CORPULS CPR system. Intubation tube with 5.0 internal diameter was used for all blind intubation attempts. First intubation success rate, median time to SAD placement, time to endotracheal intubation with SAD, and ease to perform the intubation were investigated in this study. All these parameters were better or non-inferior for iGEL in all investigated scenarios. Conclusion : Our manikin study demonstrated that iGEL was the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. What is Known: • For pediatric resuscitation, bag-mask ventilation is the first-line method for airway control and ventilation. • Endotracheal intubation is considered by many scientific societies the gold standard for airway management. • Supraglottic airway devices are particularly useful when bag-mask ventilation is difficult or impossible but can be also used for blind intubation. What is New: • The iGEL laryngeal mask turns out the most effective device for blind intubation by inexperienced physicians in different pediatric airway scenarios. • It may be a reasonable first emergency blind intubation technique for inexperienced physicians in pediatric patients in normal airway with and without continuous chest compressions, as well as in difficult airway with continuous chest compressions.

Introduction: The main causes of cardiac arrest in paediatric patients are airway obstruction and progressive hypoxia. Rapid endotracheal intubation and the implementation of mechanical ventilation during cardiopulmonary resuscitation (CPR) can affect the minimisation of chest compressions and adequate oxygenation of the blood, and thus increase the chances of spontaneous circulation return. Aim of the study: The aim of the study was to compare intubation using a standard Macintosh blade (MAC) laryngoscope and blind intubation using an Ambu® AuraGain™ Disposable Laryngeal Mask (AMBU) as a guide for the tracheal tube under simulated CPR conditions of a paediatric patient with and without chest compressions. Material and methods: Fifty-six students from the final year of medicine studies participated in this trial. The study was designed as a randomised, cross-over, simulation study. Participants of the study performed endotracheal intubation during simulated CPR of a paediatric patient, with and without chest compressions during an intubation procedure. Participants had a maximum of three attempts to intubate each of the techniques in individual research scenarios. Results: The median time of intubation in CPR without chest compressions using MAC and AMBU was 32 s (interquartile range-IQR; 27-41.5) and 30 s (IQR; 22-43), respectively. The efficacy of the first intubation trial was 28.6% for MAC and 48.2% for AMBU, and the total intubation efficiency for both techniques was 100%. In the case of intubation during uninterrupted chest compressions, blind intubation using AMBU as the guide for the endotracheal tube was associated with better parameters than in the case of intubation using MAC, with respect to both intubation time (32 s [IQR; 22-45] and 47 s [IQR; 33-57], respectively; p = 0.017), effectiveness of the first intubation trial (33.9% and 5.4%, p = 0.002), as well as the total effectiveness of intubation (73.2% and 46.2%, p < 0.001). Conclusions: In our study, blind endotracheal intubation using AMBU was associated with more effective endotracheal intubation than standard intubation using direct laryngoscopy, both when the chest compressions were interrupted for the time of intubation and in the case of intubation during uninterrupted chest compressions.

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