i-gel® from Intersurgical: clinical evidence listing

Nolan JP, Lockey D. Resuscitation 2009; 80(12): 1333-1334

This editorial discusses the options that are available for airway management when cardiac arrest occurs outside a hospital environment. It is stated that supraglottic airways are easier to insert than endotracheal tubes and have the added benefit of allowing chest compressions to continue while they are inserted. The article references i-gel® studies with both positive and negative outcomes. Overall, insertion time was quicker but ventilation was sometimes found to be inadequate. One study showed that the i-gel® had a higher leak pressure than the cLMA, however a German study found that the i-gel® produced a tight seal at 20cm H2O in only around half of the patients involved. Most of the available i-gel® data comes from small studies. Randomised controlled trials are needed to confirm the performance of the i-gel® and other supraglottic airways during CPR.

Link to abstract.

Kushakovsky V, Ahmad I. Anaesthesia 2009; 64(11): 1262

This letter is a response to a small LMA Supreme® study. The authors say that they have been using the device in patients having nasopharyngeal surgery as it protects the airway from any bleeding and has a gastric channel to remove any blood in the stomach. However, they have reviewed recent research and believe that their current practice may change. In previous studies, the i-gel® has performed as well as the LMA Supreme® even when all i-gel® patients have been given a size 4 device and the LMA Supreme® has been sized correctly. Gastric tube placement in the two devices and the LMA Proseal® is also comparable. The authors are considering the use of the i-gel® or ProSealTM instead of the SupremeTM.

Link to abstract.

Bobrow B J, Ewy G A, Clark L, Chikani V, Berg R A, Sanders A B, Vadeboncoeur T F, Hilwig R W, Kern K B. Ann Emerg Med 2009; 54(5): 656-62

Retrospective analysis of statewide out-of-hospital cardiac arrests on over 1000 patients receiving either passive ventilation or bag-valve-mask ventilation treatment by paramedics. Adjusted neurologically intact survival between ventilation techniques was the main results category compared. Passive ventilation proved more successful under the terms used.

Abstract text

Fernández Díez A, Prez Villafane A, Bermejo González JC, Marcos Vidal JM. Rev Esp Anestesiol Reanim 2009; 56: 474- 478

In this study, 85 patients were randomised into two groups for ventilation via LMA Supreme® or i-gel® supraglottic airways. Ease of insertion, seal pressure, ventilatory parameters and insertion of a gastric tube were all recorded. Both devices were easy to insert, with the SupremeTM and i-gel® being inserted on the first attempt in 95.2 and 86% of cases respectively. Performance was generally comparable.

Abstract text

Francksen H, Renner J, Hanss R, Scholz J, Doerges V, Bein B. Anaesthesia 2009; 64(10): 1118-1124

In this study, 80 patients were randomly allocated to either i-gel® or LMA-Unique® insertion before minor surgery. Ventilation, insertion time, airway pressure, leak pressure and postoperative sore throat were all measured. Results were similar for all parameters other than airway leak pressure, which was significantly higher in the i-gel® (mean pressure 29cm H2O compared to 18cm H2O). Both devices are acceptable for use in securing an airway, however the increased leak pressure is an advantage for the i-gel®.

Link to abstract.