i-gel® from Intersurgical: clinical evidence listing

Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Anaesthesia 2020 Jun; 75(6): 785-799

Severe acute respiratory syndrome‐corona virus‐2, which causes coronavirus disease 2019 (COVID‐19), is highly contagious. Airway management of patients with COVID‐19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID‐19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID‐19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID‐19. The advice in this document is designed to be adapted in line with local workplace policies.

Link to abstract

Original post by Pearson K. Reply by Cook TM. Anaesthesia Correspondence Website. 2016. Accessed 22 May.

In the original post, and in response to Cook's study on abandoning vintage laryngeal masks (Br J Anaesth. 2015 Oct;115(4):497-9), Pearson cautions against the 'universal replacement of 1st generation devices' especially considering sub-group care (paediatrics), versatility, training and cost, and instead suggests there should not be a one-size-fits-all approach. Pearson also comments on the significant move towards the use of i-gel in her hospital.

In response to this, Cook suggests clinicians use the best performing and safest device where available as first choice. Cook makes mention of the two published meta-analyses on i-gel in children: by Choi GJ and Maitra S.

Link to abstract

Cook TM, Kelly FE. Anaesthesia. 2016 Apr;71(4):466-7

Based on the findings of the DAS 2015 guidelines, the authors argue that evidence suggests 2nd generation supraglottic airway devices perform better than 1st generation equivalents, and that 2nd gen should be used for airway rescue and routine airway management.

Link to abstract

Cook TM. Br J Anaesth. 2015 Oct;115(4):633-4

Letter to the editor recommending that the term 'third generation' used when describing supraglottic airway devices is abandoned due to the confusion over the design features that determine the device's advancement. The author makes further suggestion as to how devices should be classified.

Link to abstract

Jackson KM, Cook TM. Anaesthesia. 2007 Apr;62(4):388-93

The airway arm of this trial compared devices including i-gel, Cobra, SLIPA and Laryngeal Tube Suction II. Each device was inserted twice into each manikin by ten anaesthetists, with each insertion scored and ranked. No one manikin outranked the others for all devices. i-gel insertion was 'significantly the easiest'.

Link to abstract