Nakstad AR, Sandberg M.Scand J Trauma Resusc Emerg Med. 2011 13; 19: 36
Twenty anaesthesiologists from the Air Ambulance Department at Oslo University Hospital used i-gel®, laryngeal tube LTSII™ and Macintosh laryngoscopes in two scenarios with either unrestricted (scenario A) or restricted (scenario B) access to the cranial end of the manikin. Technique selected, success rates and time to completion were primary outcomes. Results showed that in scenario B, all physicians secured the airway on first attempt, compared to 80% for ETI, whilst also completing in a quicker time. Authors conclude that ‘ETI was time consuming and had a low success rate’.
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Ruetzler K, Roessler B, Potura L, Priemayr A, Robak O, Schuster E, Frass M. Resuscitation 2011; 82 (5): 593-597
41 paramedics with no previous experience watched a lecture and demonstration. They then attempted to insert each of six supraglottic airways and an ET tube into a manikin in random order. After three months, all participants were assessed again without receiving further training. All supraglottic airways except ProSealTM were more successful than the ET tube. i-gel®, Unique® and LT-DTM had significantly faster times to insertion and ventilation than the other devices. There was no significant difference in success rates for supraglottic airways after three months, however, ET tube insertion rates decreased from 78% to 58% in that time.
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Castle N, Owen R, Hann M, Naidoo R, Reeves D. Emerg Med J 2010; 27(11): 860-86
In this study, 36 final-year paramedic students were randomised into one of six groups, each of which inserted three airway devices into a manikin in a different order. The devices used were the i-gel®, the laryngeal mask airway and the Laryngeal Tube airway. The students were timed while performing each insertion and interviewed afterwards to determine which device they preferred and why. All insertions were successful on the first attempt. The i-gel® was significantly faster than its competitors with a mean insertion time of 12.3s. Due to the speed and ease of insertion, 63% of students named the i-gel® as their preferred airway.
Link to abstract.
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Nolan J P, Soar J, Parr M J A, Perkins G D. Resuscitation 2010; 81(1): 1-4
Focus on the key studies published in Resuscitation in 2009, including cardiac arrest prevention, basic life support and CPR quality
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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.
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