Comparison of ventilation with second-generation supraglottic airway devices in a prospective randomized cadaver study

Abstract Second-generation supraglottic airway devices (SADs) are widely used alternatives to endotracheal intubation in both anesthesia and emergency airway management. The newly developed LT®evo represents a redesigned version of the established Laryngeal Tube Suction Disposable (LTS-D). This study compared the ventilatory performance of the LT®evo with endotracheal intubation and three other second-generation SADs— LTS-D, Ambu® AuraGain™ and i-gel® Plus—using a controlled human cadaver model. In this prospective, randomized experiment, six thawed adult cadavers were sequentially ventilated via an endotracheal tube (ET) and four SADs under standardized mechanical ventilation (tidal volume 7 mL/kg, PEEP 5 cmH₂O, respiratory rate 10/min). Airway pressure and flow were continuously recorded (sampling rate 200 Hz) to determine inspiratory tidal volume, pressure, flow, and calculated resistance. Endotracheal intubation using fiberoptics was attempted via LT®evo , AuraGain™ and i-gel® Plus. Data were analyzed using Kruskal–Wallis tests with Holm-corrected post-hoc pairwise comparisons. From six human cadavers (60–85kg estimated body weight), 30 complete ventilation datasets were obtained. Initial fiberoptic control of SAD placement showed optimal positioning in 13 of 24 insertions. During ventilation cycles, inspiratory tidal volumes of the LT®evo (0.49 [0.46–0.52]) were similar to those of ET, AuraGain™ and LTS-D and superior to those of the i-gel® Plus (0.31 L [0.27–0.33], p < 0.001). Peak inspiratory pressure and inspiratory resistance were higher in ET when compared to LT®evo and all other SADs. Endotracheal intubation using fiberoptics was successful in all attempts via LT®evo , AuraGain™ and i-gel® Plus. In this controlled cadaver study, the newly designed LT®evo demonstrated ventilatory performance comparable to that of the LTS-D and the Ambu® AuraGain TM and was superior to the i-gel® Plus in delivering adequate tidal volumes. Additionally, LT®evo allowed for fiberoptic ET placement. Importantly, these results are specific to the cadaveric model and reflect technical variability in ventilation mechanics rather than clinical effectiveness. Clinical trial number German Clinical Trials Registry, DRKS00038309, on October 30 th , 2025.