The use of supraglottic airway (SGA) devices during CPR is associated with a lower incidence of regurgitation when compared to face mask ventilation (FMV). Endotracheal intubation (ETI) remains the most effective and safest technique, but requires great skill that must be maintained by regular practice to be efficient and avoid complications. The optimal airway management strategy during CPR and after ROSC is uncertain. found that a 10% increase in CCF is approximately equal to an 11% increase in survival. Human clinical trials have shown that maintaining a high CCF is linked to a higher rate of return of spontaneous circulation (ROSC), survival, and favourable neurological outcomes both in shockable and non-shockable rhythms. In animal studies, continuous compressions are associated with a higher rate of good neurological outcomes compared to a 30:2 regimen. The latest European Resuscitation Council (ERC) recommendations emphasize the importance of applying the highest possible quality of chest compressions with minimal interruption, and the American Heart Association (AHA) recommendations state that the CCF should be equal to at least 60%, and ideally exceed 80%. The chest compression fraction (CCF) is the proportion of time spent performing compressions, and can be increased by minimizing interruptions. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers’ self-assessed cognitive load.Īchieving high-quality cardiopulmonary resuscitation (CPR) requires the provision of chest compressions of adequate depth and rate while avoiding interruptions. The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel ® supraglottic device to deliver asynchronous ventilations). This is a protocol for a multicenter, parallel, randomized simulation study. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. The optimal airway management strategy during cardiopulmonary resuscitation is uncertain.
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