Comparison of bag-valve-device ventilation and volume-controlled ventilation with laryngeal tube evo in intra-arrest ventilation—a prospective randomized study in human body donors

Abstract Background This study evaluated the effects of the new supraglottic airway device known as laryngeal tube evo on target parameters of ventilation therapy during mechanical chest compressions in intra-arrest ventilation with bag-valve-device ventilation vs. volume-controlled ventilation. Methods Thiel-embalmed human body donors were included in a standardized resuscitation scenario. Ventilation was performed in a randomized order using the laryngeal tube evo for bag-valve-device ventilation and volume-controlled ventilation during mechanical cardiopulmonary resuscitation. Expiratory (Vt e ) and expiratory tidal volumes per kg body weight (Vt e /kgBW); delta tidal volume (difference between ideal and expiratory tidal volume; ΔVt); leakage volume ( V leak ); peak ( P peak ); mean ( P mean ) and plateau ( P plat ) pressures and respiratory rates were recorded. The primary efficacy endpoint was Vt e . Results Five body donors were included. Although one donor (20%) was successfully ventilated with all ventilation modes, three could only be ventilated with one of the modes (bag-valve-device ventilation = 20%; volume-controlled ventilation = 40%). One donor (20%) could not be sufficiently ventilated with any of the modes. Mean Vt e was 91.73 ± 66.3 ml with bag-valve-device ventilation versus 142.93 ± 115.05 ml with volume-controlled ventilation. The comparison of both ventilation modes revealed higher Vt e (50.27 ml; 95% confidence interval (CI): 7.56 to 92.97; p = 0.02), Vt e /kgBW (0.8 ml; 95% CI: 0.05 to 1.56; p = 0.04), P mean (5.23 mbar; 95% CI: 4 to 6.47; p < 0.0001) and P plat (10.36 mbar; 95% CI: 8.08 to 12.64; p < 0.0001), but lower ∆Vt (− 50.3 ml; 95% CI: − 93 to − 7.59; p = 0.02) and respiratory rates (− 10.83/min; 95% CI: − 17.29 to − 4.36; p = 0.001) for volume-controlled ventilation. Conclusions Comparing volume-controlled ventilation with bag-valve-device ventilation for asynchronous ventilation during mechanical cardiopulmonary resuscitation using the laryngeal tube evo, volume-controlled ventilation resulted in higher Vt e and Vt e /kgBW, but lower ∆Vt and respiratory rates. Future studies should evaluate laryngeal tube evo in prehospital use during mechanical cardiopulmonary resuscitation. When doubts regarding its effectiveness are present, synchronous ventilation (30:2) should be performed. Trial registration German Clinical Trials Register; unique identifier: DRKS00037836. Registered on September 09, 2025 [1].