The i-gel supraglottic airway as an alternative in the preclinical emergency medical aid? A comparative study on a manikin

Introduction

Endotracheal intubation (ET) is the recognised gold standard for securing an airway in the realm of preclinical emergency medical aid. Supraglottic airway devices present a valid alternative in the case of an elevated incidence of difficult airway securing and intubation preconditions. Due to positive experiences with the i-gel supraglottic airway, we - through a joint paramedic (PM) and doctor (DR) team - have compared its use under standardised conditions with the classic laryngeal mask (cLMA) and the laryngeal tube (LT) using an airway simulator.

Methods

Seventy-one probands (40 PM and 31 DR) took part in this study. The airway simulator used was the Ambu^® Airway Man. Timekeeping started with the laying aside of the anaesthesia bag after successful ventilation of the airway simulator and ended after having ensured sufficient ventilation. Participants used three different devices (i-gel size 4, cLMA size 3 and LT size 4) each five times. Additionally, an interval time was measured after successful ventilation with the i-gel. Without interruption, participants continued the experiment with two interval ventilations and conducted a secondary ET through the i-gel. Timekeeping ended in this case after the first ventilation.

Results

Prior to the study 95% of PM had previous experience with the cLMA, 77.5% with the LT and 0% with the i-gel. Respective percentages for DR were 61.2% for the cLMA, 38.7% for the LT and 32.2% for the i-gel (P < 0.001 respectively). Across the entire group of 71 study participants, users required an average of 16.6 seconds for the successful insertion of the cLMA, 15 seconds for the LT and 8.48 seconds for the i-gel. When comparing the PM with the DR, the PM required 16.5 seconds for the cLMA (vs 16.9 seconds, P = 0.693), 14.9 seconds for the LM (vs 16.8 seconds, P = 0.08) and 7.8 seconds for the i-gel (vs 9.4 seconds, P = 0.001). The total time needed for secondary ET was on average 25.8 seconds (PM 24.2 seconds, DR 27.9 seconds, P < 0.001). Error-free insertion at all five incidents was achieved by 73.3% of DR and by 46.1% of PM (P < 0.001).

Conclusions

Sufficient ventilation was achieved 50% faster through the i-gel when compared with the cLMA and the LT. The correct usage of the i-gel can be learnt quickly. The i-gel allows the options of secondary ET.