i-gel® from Intersurgical: clinical evidence listing

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.

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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.

Bobrow B J, Ewy G A. Curr Opin Crit Care 2009; 15(3): 228-33

A discussion on recent findings surrounding the role of ventilation during CPR during OHCA, focusing on whether passive oxygen insufflation is an optimal form of ventilation when compared to intubation and active assisted ventilation. The authors summarise and suggest that training prehospital medical providers to use passive insufflation may increase critical organ perfusion and therefore survival after OHCA.

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Garza AG, Gratton MC, Salomone JA, Lindholm D, McElroy J, Archer R. Circulation 2009; 119(19): 2597-605

A retrospective observational cohort study reviewing all adult primary ventricular fibrillation and pulseless ventricular tachycardia cardiac arrests before and after protocol changes in the Emergency Medical System in Kansas City in the USA. Survival from out-of-hospital cardiac arrest of presumed cardiac origin improved from 7.5% to 13.9%, and survival to hospital discharge increased from an unadjusted rate of 22.4% to 43.9%. Authors confirm that the protocol changes optimising chest compressions with reduced disruptions improved return of spontaneous circulation and survival to discharge in their patients.

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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.