Posted by: medicblog999 | April 4, 2009

Supraglottic Airways

06-10igel-k

Firstly, the disclaimer.

The following post is soley my view, it does not in any way, shape or form give any endorsement of the iGel Laryngeal Mask from the North East Ambulance Service NHS Trust.

I was recently asked to trial a couple of new (for us) laryngeal mask airways. With the recent trend to move away from endotracheal intubation (ETT) and instead move towards supraglottic airways, my service has been looking at the alternatives to the current Laryngeal Mask Airways (LMAs) that we are using.

There has been a definite and obvious lack of support for the change to remove ETT as our first line definitive airway management device. There are many arguments for this, the most noticeable being the lack of belief and trust in LMAs to ensure a good seal for ventilation and protection from aspiration of gastric contents into the lungs during an active resuscitation. There is also a common held belief that paramedics want to retain the use of ETT simply because it is a skill which they do not want to loose and one that some feel defines their ability and higher skill level than some other ambulance workers.

I have been one of those paramedics who has been very reluctant to choose LMA instead of an ETT. I have always felt confident in my tubes, I know that once it is in place and secure, it is unlikely that the patient will aspirate stomach contents. It is most probable that I will have an excellent seal for airway ventilation when using the ventilator on the vehicle and  once the tube is secured well I can pretty much get on with CPR whilst en route to the A&E.

Over the last 10 days, I have had the opportunity to use the iGEL LMA twice. This product is designed with a gel filled head which negates the need for deflation prior to insertion and inflation after insertion. When I first saw the device, I was impressed with how easy it looked to insert and without the need for deflation/inflation, how quickly I would be able to place it in the patient and commence ventilation’s.

In both of the arrests, I didn’t even bother with an oropharyngeal airway and bag valve mask. I instead opted to insert the iGel LMA in the first instance to secure the airway and begin ventilating the patient. The device was in place within 10-15 seconds from having the package in my hand. It seemed to sit very securely, and I was getting very good ventilation pressures, with very minimal leakage. There was no problem with gastric contents in either case and the device did not move from its position despite the obvious movement of the patient from floor to chair, chair to vehicle then vehicle to stretcher.

I am very impressed with this product so far. As far as I can see, the only way to get paramedics to move away from ETT to LMA airways, is to find one that is effective in its function, fit for purpose and very easy and quickly to insert. Once all of these boxes have been ticked, then it is hard to justify taking the time and effort to place an ETT in each and every cardiac arrest scenario.

We are fortunate that our service is not taking ETT`s off our vehicles and out of our kit bags. They just want us to consider a supraglottic device (LMA), the first choice for airway management in these cases. It is still our clinical decision what airway device we ultimately use. My opinion has changed greatly, and im sure others will change once they have used this device.

supremeI am also trialing the LMA supreme, which is from a different manufacturer.

This one still has the inflatable head, so will take longer to insert, but also has its own list of ‘unique benefits’ which distinguish it from other devices. I plan on using this one for the next 2 arrests, then alternating after those. Ill let you know how that goes after I have used them.

I would be interested to hear if any of you use either of these devices and what your thoughts are, especially in relation to the change in direction for definitive airway management. What are your thoughts??

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Responses

  1. I have used several LMA’s (including the 2 you mention)and the best is from Ambu. Try the Ambu Once disposable Laryngeal mask.
    http://www.ambu.com

  2. The British Red Cross will be using the LMAs pretty soon from what I heard, I think they’re very good and really easy to insert. The BRCS will also be using the iGel ones, it would definitely help with the few unresponsive casualties they get 🙂

  3. Hi

    I read your article with interest and would like to thank you for taking the time to evaluate i-gel and for sharing your findings with others. I am a long time Ex Paramedic and now work for Intersurgical and was wondering if you could either contact me or let me have a phone number I could contact you, to discuss the possibility of re printing your article in one of the mainstream Ambulance publications.

    I look forward to hearing back from you.

    Mark Ellis
    UK Sales & Marketing Manager
    Intersurgical
    07774 112767

  4. I am not using either of those devices, but I have been involved w/ a system that uses the King LTS-D as a first line advanced airway.

    I personally have had much better results w/ this airway than w/ the use of the Combi-tube (we had trialed the Combi-tube as first line for a time as well).

    It is quite easy to place (blind insertion, much like a long OPA), and it can be inserted by an EMT-B. This allows me to immediately begin ALS interventions.

    http://www.kingsystems.com/PRODUCTS/AirwayDevices/KINGLTSD/tabid/87/Default.aspx

  5. Mark

    I have been trying to email you for some time but email is being rejeced, could you please contact me.

    Regards

    Mark Ellis


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