Comparison of laryngeal tube evo with tracheal intubation during intra-arrest-ventilation using biphasic positive pressure ventilation - a prospective randomized controlled body donor study

BACKGROUND: This study evaluates the effects of the new supraglottic airway-device laryngeal tube evo (LT®evo) versus that of tracheal intubation (TI) concerning the target parameters of ventilation therapy during mechanical chest compressions in intra-arrest-ventilation with biphasic-positive-airway-pressure-ventilation.METHODS: This prospective randomized crossover study involving Thiel-embalmed human body donors, compares TI with LT®evo using biphasic-positive-airway-pressure-ventilation during mechanical cardiopulmonary resuscitation. Each body donor underwent ventilation with both airway-devices in randomized order. Ventilatory parameters were recorded at ventilator flow sensors. Primary endpoint was expiratory tidal volume (VTe), secondary endpoints included expiratory tidal volume per kg ideal body weight (VTe/kgIBW); delta tidal volume (ideal-VTe; ΔVT); leakage volume (VLeak); peak (PPeak), mean (PMean), plateau (PPlat) pressures; and respiratory rates.RESULTS: Five body donors were included. Linear regression analyses with random intercepts revealed lower VTe (-295.7 ± 8 ml; 95%CI:-339.2 to -252.2); p < 0.0001), VTe/kgIBW (-5.0 ml/kg; 95%:-5.7 to -4.2; p < 0.0001), PPeak (-19.0mbar; 95%CI:-23.1 to -14.9; p < 0.0001) and PMean (-2mbar; 95%CI:-3.2 to -0.8 ;p = 0.001) but higher ∆VT (296.0 ml; 95%CI:252.5 to 339.4; p < 0.0001) and VLeak (52.7%; 95%CI:41.6 to 63.7; p < 0.0001) for LT®evo. While all tracheal-intubated body donors (100%) were successfully ventilated with biphasic-positive-airway-pressure-ventilation (VTe/kgIBW > 2 ml/kg), only one of five body donors (20%) could be ventilated via LT®evo.CONCLUSION: In this body donor model of biphasic-positive-airway-pressure-ventilation during mechanical cardiopulmonary resuscitation, TI provided higher VTe and lower leakage than LT®evo did. LT®evo ventilation frequently failed to achieve tidal volumes above the estimated dead space. These findings suggest that LT®evo may be poorly suited for intra-arrest ventilation using biphasic-positive-airway-pressure-ventilation during mechanical cardiopulmonary resuscitation. When the LT®evo is used in this setting, a synchronous 30:2 ventilation strategy may represent a safer alternative.TRIAL REGISTRATION: German Clinical Trials Register; unique identifier: DRKS00037836; registration date: September 09, 2025.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-026-05902-4.