i-gel® from Intersurgical: clinical evidence listing

Kellum M J, Kennedy K W, Barney R, Keilhauer F A, Bellino M, Zuercher M, Ewy G. Ann Emerg Med 2008; 52(3): 244-52

The objective of this study was to compare a newly implemented protocol using the principles of cardiocerebral resuscitation against 2000 American Heart Association Guidelines for treatment of out-of-hospital cardiac arrest. Data was collected retrospectively from the two study groups, each spanning a three-year period. Cerebral performance category scores were used to define the neurological status of survivors, with ‘1’ considered as ‘intact’ survival. Prior to the protocol change, 18 of 92 (20%) survived and 14 (15%) were intact. After the implementation, 42 of 89 (47%) survived and 35 (39%) were intact. Authors conclude that the implementation was associated with ‘a dramatic improvement in neurologically intact survival.’

Abstract text

Mustafaeva MN, Mizikov VM, Kochneva ZV, Vashchinskaia TV, Sarkisova NG, Rusakov MA, Levitskaia NN. Anesteziol Reanimatol 2008; (5): 55-58

This paper describes the development of supraglottic airways and the i-gel® in particular. A review of the available i-gel® literature showed that there are considerable benefits to using the device during general anaesthesia. The experiences of the authors during the use of i-gel® in 34 patients are also described. The authors believe that the i-gel® is suitable for use during anaesthesia and potentially resuscitation. However, more research should be carried out, especially in terms of comparison with other supraglottic airways.

Link to abstract.

Acott CJ. Diving and Hyperbaric Medicine 2008; 38(3): 124-127

This study looked at the use of i-gel® in airway management of a patient in a diving bell or deck decompression chamber. The study highlighted the potential limitations of some supraglottic airways used in Hyperbaric Medicine, such as possible cuff expansion with a decrease in pressure on decompression and change in cuff volume due to gas diffusion as the gas mixtures change, problems not associated with i-gel®. It showed that, subjectively, there was no change in the consistency of the i-gel® at 203 and 283kPa pressure and that no bubbles were detected following decompression from 203, 283 or 608kPa. The i-gel® was also preferred by the Diver Medical Technicians (DMTs) to the alternative device included in the manikin section of the study because it ‘lacked a cuff and was easier to insert from any position’.

Link to abstract.

Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM. Anaesthesia 2008; 63(9): 991-995

This study evaluated the performance of i-gel® in manikins and anaesthetised patients when used by novices. The i-gel® was deployed with minimal evidence of patient trauma and 100% insertion success. In their summary, the authors concluded that, ‘i-gel® is rapidly inserted in both manikins and patients by novice users and compares favourably to other supraglottic airways available. Further work determining safety and efficacy during cardio-pulmonary resuscitation is required.’

Link to abstract.

Joshi NA, Baird M, Cook TM. Anaesthesia 2008; 63(9): 1010-1026

A middle-aged female patient was scheduled for an elective operation on her hand. She had undergone several general anaesthetics in the past when a cLMA had been used without documented problems. She had a Mallampati score of three and a thyromental distance of 6cm. Face mask ventilation with an oropharyngeal airway was extremely difficult. A pLMA was inserted, but ventilation was not possible. A size four cLMA was also tried with the same result. A size four i-gel® was then inserted. This immediately provided unobstructed ventilation and stable oxygenation saturation of 98%. The authors commented that ‘the i-gel®’s role in difficult airway management remains to be established, but its ease of insertion, short wide airway tube and good airway leak pressures make it a potentially useful airway device in cases of difficult mask ventilation.’

Link to abstract.