Rapid Airway Placement Without Pausing Chest Compressions: Supraglottic Airway Versus Endotracheal Intubation

To compare supraglottic airway device (i-gel) placement versus endotracheal intubation during neonatal cardiopulmonary resuscitation (CPR) and to assess whether ongoing chest compressions affect success or procedure time in a manikin simulation.

We conducted a randomized crossover neonatal resuscitation simulation for pediatric and junior residents at a single tertiary hospital. A term 3-kg infant scenario required positive-pressure ventilation and chest compressions. Participants performed 15 cycles of CPR, placed an advanced airway, and then continued CPR for 15 cycles. Each participant completed four conditions: endotracheal intubation with and without chest-compression interruption, and i-gel placement with and without interruption. Outcomes were success rate and procedure time (from device pickup to ventilation).

Twelve residents participated. Endotracheal intubation success rates were 92% (11/12) without interruption and 83% (10/12) with interruption; median procedure times were 16.5 s (range 13-84) and 16 s (11-24), respectively. i-gel placement succeeded in 100% (12/12) in both conditions and was faster: median 7.5 s (6-11) without interruption and 7 s (6-10) with interruption. In paired comparisons, i-gel was significantly faster than intubation in both conditions (paired Wilcoxon p < 0.01), whereas success rates did not differ significantly (McNemar exact p > = 0.50).

In this neonatal manikin simulation, i-gel placement enabled earlier initiation of ventilation than endotracheal intubation and remained consistently successful and rapid even during ongoing chest compressions. Chest-compression interruption did not significantly change intubation success or time in this small sample.