Performance of the new Laryngeal Tube LT®evo during simulated resuscitation: a randomised crossover manikin study

Effective airway management is essential for high-quality cardiopulmonary resuscitation (CPR). While tracheal intubation (TI) has traditionally been regarded as the reference technique for advanced airway management, it requires substantial expertise and may prolong no-flow time during CPR. Current European Resuscitation Council (ERC) guidelines recommend the i-gel® as the preferred supraglottic airway (SGA). The newly developed Laryngeal Tube LT®evo (VBM Medizintechnik, Germany) was designed to simplify insertion and improve ventilation performance. This study evaluated its efficacy compared with bag-valve-mask-ventilation (BVM) and tracheal intubation (TI) in a standardized resuscitation scenario. In this prospective, randomised crossover manikin study, 20 anaesthesiologists with varying experience in prehospital and in-hospital Airway management during CPR performed three resuscitation scenarios using BVM, TI, or LT®evo in random order. Each 5-minute scenario simulated a cardiac arrest with initial shockable rhythm and required up to three mandatory defibrillations. The primary endpoint was total no-flow time. Secondary endpoints included device insertion time, time-to-first-effective-ventilation (tidal-volume ≥ 400 mL), and number of insufficient ventilations. All 60 simulations were completed. Compared with LT®evo, BVM produced statistically longer no-flow time (regression coefficient [RC] = 4.00; 95%-CI = 0.13–7.87), a higher rate of insufficient ventilations (RC = 1.25; 95%CI = 0.44–2.09), and lower tidal-volumes (RC = − 66.05; 95%CI = − 124.75- −7.35). Compared to LT®evo, there was no evidence for a difference in no-flow time for TI (RC = − 2.17; 95%CI = − 6.04–1.70) in experienced users. In this first evaluation of the LT®evo, the device enabled rapid, effective ventilation with minimal interruption of chest compressions. Its ease of use and observed performance characteristics support further clinical investigation as potential alternative SGA for resuscitation.