i-gel® from Intersurgical: clinical evidence listing

Bamgbade OA, Macnab WR, Khalaf WM. Eur J Anaesthesiol 2008; 25(10): 865-866

This letter reported that first time insertion with i-gel® was achieved in <5 seconds in 290/300 patients. Three patients with difficult airway underwent successful fibreoptic endotracheal intubation through i-gel® and all patients underwent adequate pressure mode ventilation with airway pressures of 10-30cm H2O initially and spontaneous breathing subsequently. In addition, lubricated gastric tubes were easily inserted through the gastric channel at the first attempt in all 80 cases where this was performed. The authors concluded that ‘i-gel® is very suitable for peri-operative airway management, positive pressure ventilation and weaning from ventilation. It is also useful as an intubation aid and has a potential role in airway management during resuscitation.'

Link to abstract.

Kellum M J, Kennedy K W, Barney R, Keilhauer F A, Bellino M, Zuercher M, Ewy G. Ann Emerg Med 2008; 52(3): 244-52

The objective of this study was to compare a newly implemented protocol using the principles of cardiocerebral resuscitation against 2000 American Heart Association Guidelines for treatment of out-of-hospital cardiac arrest. Data was collected retrospectively from the two study groups, each spanning a three-year period. Cerebral performance category scores were used to define the neurological status of survivors, with ‘1’ considered as ‘intact’ survival. Prior to the protocol change, 18 of 92 (20%) survived and 14 (15%) were intact. After the implementation, 42 of 89 (47%) survived and 35 (39%) were intact. Authors conclude that the implementation was associated with ‘a dramatic improvement in neurologically intact survival.’

Abstract text

Wharton NM, Gibbison B, Gabbott DA, Haslam GM, Muchatuta N, Cook TM. Anaesthesia 2008; 63(9): 991-995

This study evaluated the performance of i-gel® in manikins and anaesthetised patients when used by novices. The i-gel® was deployed with minimal evidence of patient trauma and 100% insertion success. In their summary, the authors concluded that, ‘i-gel® is rapidly inserted in both manikins and patients by novice users and compares favourably to other supraglottic airways available. Further work determining safety and efficacy during cardio-pulmonary resuscitation is required.’

Link to abstract.

Nolan JP, Soar J. Curr Opin Crit Care 2008; 14(3): 279-286

This review by Jerry Nolan and Jasmeet Soar discusses the advantages and disadvantages of various methods of airway management during cardiopulmonary resuscitation, and the role of ventilation during out-of-hospital CPR. In the section on supraglottic airways, i-gel® was one of a number of devices mentioned. It confirmed that the ease of insertion of the i-gel® and its favourable leak pressure make it ‘theoretically very attractive as a resuscitation device for those inexperienced in tracheal intubation’. It also confirmed further study was required.

Link to abstract.

Gatward JJ, Thomas MJC, Nolan JP, Cook TM. Br J Anaesth 2008; 100(3): 351-356

In this study, 40 volunteer doctors regularly involved in CPR, were timed inserting four different airway devices, including i-gel® and a tracheal tube, with and without stopping chest compressions. Comparison of the speed of insertion of the different devices during CPR allowed ranking of the devices. The i-gel® was inserted approximately 50% faster than the other devices tested.

Link to abstract.