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Abstract: Aim This study investigates if a n impedance threshold valve (ITV) might improve survival after cardiac arrest by increasing vital organ blood flow. The combination of ITV and supraglottic airway devices (SADs) has not been previously studied. This simulation study in a manikin aimed at analysing differences in ventilation with different SADs without and with an ITV. Methods: In a resuscitation manikin, cardiopulmonary resuscitation (CPR) was performed with interrupted (30:2) and continuous chest compressions using facemask, tracheal tube and 10 SADs (six different laryngeal masks, LT-D, LTS-D, Combitube® and Easy Tube®). Ventilation was performed with and without an ITV. A total of 550 CPR cycles of 3-min duration were performed with chest compressions and ventilation standardised by use of a mechanical thumper device and an emergency ventilator. Results: Sufficient ventilation was possible with all devices tested. For ventilation during continuous chest compressions, there were significantly reduced tidal volumes for all airway devices with ITV use. By contrast, during interrupted chest compressions, no differences in tidal volumes with the ITV occurred in the majority of devices. The maximum reduction of tidal volume for any device was 7.8% of the volume reached without the ITV. Conclusion: Based on the findings of this manikin trial, the use of an ITV for ventilation during CPR is possible in combination with supraglottic airway devices. Merging these two strategies warrants further clinical evaluation to judge the relevance of tidal volume reduction found in this trial. [ABSTRACT FROM AUTHOR]

Every physician involved in emergency medicine should be familiar with alternative techniques for managing the difficult airway. We report a case of a patient who was successfully ventilated and oxygenated with a laryngeal tube, when tracheal intubation failed. Ventilation was possible even during continuous chest compressions. Airway equipment, including one supraglottic alternative for patients of all ages and a set for cricothyroidotomy, for those experienced in its use, should be available on every ambulance equipped for advanced life support. [Copyright &y& Elsevier]