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.

Campbell J, Michalek P, Deighan M. Resuscitation 2009; 80(8): 963

This case report details the case of a 54-year-old man with acute respiratory failure, who had a grade four view at laryngoscopy. He was difficult to bag-mask ventilate and a laryngeal mask was inserted as an airway rescue technique. As ventilation was not possible with this device, it was removed and a size four i-gel® inserted. This allowed good ventilation. A fibrescope was passed down the airway channel and a 7.0mm endotracheal tube passed over the fibrescope and through the i-gel®. The i-gel® was then removed, leaving the airway secure.

Link to abstract.

Thomas M, Benger J. Resuscitation 2009; 80(12): 1437

This correspondence article describes 12 attempts to ventilate patients in cardiac arrest using the i-gel®. The device could usually be inserted on the first attempt; however, on seven out of 12 occasions ventilation was then found to be inadequate. The i-gel®s were correctly positioned, but there were large leaks. The authors state that the reason for this is unclear, but that the device may be harder to position correctly when patients are not in the most appropriate position for insertion. An alternative explanation is that higher pressure is needed to ventilate the lungs after cardiac arrest, in which case other supraglottic airways should have the same problem.

Link to abstract.

Wiese CHR, Bahr J, Popov AF, Hinz JM, Graf BM. Resuscitation 2009; 80(1): 100-103

This paper compared i-gel® to another supraglottic airway in a manikin cardiac arrest scenario. The study evaluated the effect use of these devices had on No-Flow Time (NFT). The authors stated that ‘an ideal supraglottic airway should be inserted rapidly with minimal training and it should enable controlled ventilation’. i-gel® met those criteria during resuscitation in a manikin and NFT was kept as low as possible, consistent with ERC guidelines.

Link to abstract.

Nolan J. Resuscitation 2008; 76(1): 1-2

From the abstract: ‘Tracheal intubation has long been regarded as a fundamental and essential component of advanced life support (ALS). It has been assumed that tracheal intubation improves the chances of surviving from cardiac arrest. There are no reliable data to support this belief and there are several reasons why attempted intubation can be harmful, particularly when undertaken by inexperienced individuals.’

Abstract text