Effect of SALAD Technique on CPR Quality During Intubation in Contaminated Airways: A Randomized Controlled Manikin Simulation Study

<b>Background:</b> The management of contaminated airways potentially compromises the quality of cardiopulmonary resuscitation (CPR). <b>Objectives:</b> This study examined the effect of suction-assisted laryngoscopy airway decontamination (SALAD) compared to intermittent suction in maintaining CPR quality during intubation in a simulated scenario of regurgitation. <b>Methods:</b> This randomized controlled manikin simulation study employed a manikin to simulate the regurgitation of gastric contents into the oropharynx during CPR. A total of 36 emergency medical technician-paramedics participated in this study. Following a 2.5 h training on the SALAD technique, all participants were randomly assigned to use either the SALAD technique (<i>n</i> = 18) or intermittent suction (<i>n</i> = 18) during intubation on the manikin. The primary outcomes were CPR quality metrics, including chest compression rate, depth, and interruption time. The secondary outcomes were intubation success rate, intubation time, and glottic visualization during intubation. <b>Results:</b> The SALAD group demonstrated significantly higher chest compression rates compared to the intermittent suction group, both before (115.7 vs. 110.9 bpm, <i>p</i> < 0.01) and during intubation (112.9 vs. 108.4 bpm, <i>p</i> < 0.05). The proportion of compression depths ≥ 5 cm was higher in the SALAD group than in the intermittent suction group, both at preintubation (61.6% vs. 44.4%) and intubation periods (55.6% vs. 27.8%). However, these differences were not statistically significant. No significant difference was observed between the two groups regarding compression depths and interruption times. A significant decrease of 2.8 bpm was observed in the compression rate of the SALAD group during intubation compared to the preintubation period (<i>p</i> < 0.01). In the intermittent suction group, both compression rates and depths exhibited a significant reduction during intubation (both <i>p</i> < 0.01) compared to the preintubation period. Intubation first-pass success rate and intubation time were comparable between the two groups. While the best glottic visualization prior to intubation was comparable between the groups, during intubation, the SALAD group demonstrated a significantly higher proportion of complete glottic visibility compared to the intermittent suction group (72.2% vs. 22.2%, <i>p</i> < 0.01). <b>Conclusions:</b> The SALAD technique achieved higher chest compression rates and provided better glottic visualization compared to intermittent suction during intubation in contaminated airways.