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Effect of SALAD Technique on CPR Quality During Intubation in Contaminated Airways: A Randomized Controlled Manikin
Li-Wei Lin1,2,3, James DuCanto4, Yung-Cheng Su5
1Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Emergency Medicine International
|July 31, 2025
Summary
The Suction-Assisted Laryngoscopy Airway Decontamination (SALAD) technique improved chest compression rates and glottic visualization during simulated airway contamination. This method offers better quality cardiopulmonary resuscitation (CPR) compared to intermittent suction during intubation.
Area of Science:
- Emergency Medicine
- Critical Care
- Airway Management
Background:
- Contaminated airways can negatively impact cardiopulmonary resuscitation (CPR) quality during airway management.
- Effective airway decontamination is crucial for maintaining optimal CPR performance in simulated regurgitation scenarios.
Purpose of the Study:
- To compare the efficacy of the Suction-Assisted Laryngoscopy Airway Decontamination (SALAD) technique against intermittent suction.
- To evaluate the impact of these techniques on CPR quality metrics and intubation success during simulated gastric content regurgitation.
Main Methods:
- A randomized controlled manikin simulation study involving 36 emergency medical technician-paramedics.
- Participants were trained in the SALAD technique and then randomly assigned to use either SALAD or intermittent suction during simulated intubation with regurgitation.
- Primary outcomes included chest compression rate, depth, and interruption time; secondary outcomes were intubation success, time, and glottic visualization.
Main Results:
- The SALAD group exhibited significantly higher chest compression rates both before and during intubation compared to the intermittent suction group.
- While not statistically significant, the SALAD group showed a higher proportion of adequate compression depths.
- The SALAD technique resulted in significantly better glottic visualization during intubation (72.2% vs. 22.2%) and less reduction in compression rate compared to intermittent suction.
Conclusions:
- The SALAD technique is superior to intermittent suction in maintaining chest compression rates during intubation in simulated contaminated airway scenarios.
- SALAD provides enhanced glottic visualization, potentially improving intubation success rates in challenging airway situations.
- These findings suggest SALAD is a valuable technique for improving CPR quality in emergency airway management.
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