iGEL vs laryngeal tube for airway management during a normal airway scenario
Sir,
We read with a great interest the article entitled“Which option for ventilation is optimal for resuscitation performed by nurses? Pilot data” [1]. The authors in this article compare the effectiveness of venti-lation using a self-expanding bag with a face mask and a self-expanding bag with a connected iGEL supraglottic device. The current American Heart Association guidelines allow the usage of supraglottic devices for ventilation during resuscitation. Additionally after verifying the correctness of the device installation they allow for continuous chest compressions without the need for breaks to perform breaths [2]. Admittedly, the Kaminska et al. [1] was carried out in simulated cardio-pulmonary resuscitation conditions, however, as indicated by numer-ous studies supraglottic ventilation devices are also applicable in other situations, such as intubation of a traumatic patient [3] or during face-to-face intubation [4]. The effectiveness of ventilation devices was also compared with numerous video laryngoscopes, where the analyzed parameters were: effectiveness of respiratory protection and ventilation by SADs. There were also “blind intubation” attempts where supraglottic ventilation devices were also used as a guide for the endo-tracheal tube [5-7]. To sum up the aforementioned studies the supraglottic ventilation devices are characterized by high effectiveness of airway patency protection and short time of performing the proce-dure. The search for new methods of maintaining the airway patency takes a special place in emergency medicine as the rapid execution of these procedures is crucial for the patient's survival.
The aim of this study was to compare the time it takes to provide full airway patency protection utilizing two different supraglottic ventila-tion devices.
The study was conducted in the medical simulation laboratory in January 2018. The study included 32 paramedics with work experience of over 5 years. The study's methodology was based on the cross-over randomized study by Ladny et al. [6]. Prior to the study, all participants took part in a 2-hour airway management training during which the correct way of using the iGEL and the laryngeal tube was demonstrated. After the demonstration of correct way of using the devices, the partic-ipants were asked to perform airway patency protection with the afore-mentioned methods. Both the order of the SADs and the order of the participants were randomized. In order to simulate a traumatic patient, MegaCode Kelly™ advanced life support manikin (Laerdal Medical, Sta-vanger, Norway) was used and it's cervical spine was secured with a standard Patriot cervical extraction collar (Össur Americas, Foothill Ranch, CA, USA) applied to the manikin neck by an independent instruc-tor. In the study the time of securing airway patency, defined as the time from grabing the device to thefirst attempt of ventilation of a patient was analyzed. In addition, the easiness of performing the procedure
American Journal of Emergency Medicine xxx (2018) xxx–xxx YAJEM-57340; No of Pages 2
Togay Evrin PhD, MD Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey Marcin Madziala DPH, EMT-P International Institute of Rescue Research and Education, Warsaw, Poland Department of Emergency Medicine, Medical University of Warsaw, Poland Corresponding author at: Department of Emergency Medicine, Medical University of Warsaw, 4 Lindleya str., 02-005 Warsaw, Poland. E-mail address:mmadziala262@gmail.com. 4 February 2018 Available online xxxx https://doi.org/10.1016/j.ajem.2018.02.029
was evaluated on a 100-point scale (1 = procedure easy to perform, 100 = procedure difficult to perform).
The mean age of participants was 35.5 ± 4.5 years, and mean work experience in emergency medicine was 7.8 ± 3.5 years. All participants of the study declared the ability to perform endotracheal intubation with a Macintosh laryngoscope and the ability to perform cardiopulmo-nary resuscitation according to the European Resuscitation Council 2015 guidelines.
Median time of airway management using iGEL was 5.5 ± 1 s vs 8.5 ± 1.5 s for laryngeal tube. The time difference in airway protection was statistically significant (p b 0.05). The easiness of providing airway pa-tency protection with the use of the tested devices was 10.5 ± 8 points for iGEL, vs 14.5 ± 10 points for laryngeal tube (p = 0.043). In compar-ison, the time of performing endotracheal intubation of an adult in the conditions of immobilization of the cervical spine in the Smereka et al. was 27 [IQR; 20–34] seconds, with an intubation efficiency of 90% [8]. And for pediatric patient, studies indicate that the time of performing intubation of a child with cervical spine immobility performed by para-medics was 29.5 [IQR, 24.5–37] seconds.
In conclusion, supraglottic ventilation devices are a viable alterna-tive to endotracheal intubation, allowing for a fast airway secure. Source of support
No sources offinancial and material support to be declared.
References
[1] Kaminska H, Gawel W, Wieczorek W. Which option for ventilation is optimal for re-suscitation performed by nurses? Pilot data. Am J Emerg Med 2018.https://doi.org/ 10.1016/j.ajem.2018.01.072.
[2] Sip M, Dabrowska A, Prucnal K, Puslecki M, Klosiewicz T. Supraglottic devices—future or everyday life? Disaster Emerg Med J 2017;2(2):74–83.https://doi.org/10.5603/ DEMJ.2017.0015.
[3]Dodd KW, Driver BE, Reardon RF. Trauma patients presenting with a King laryngeal tube™ in place can be safely intubated in the emergency department. Am J Emerg
0735-6757/© 2018 Elsevier Inc. All rights reserved.
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Please cite this article as: Evrin T, Madziala M, iGEL vs laryngeal tube for airway management during a normal airway scenario, American Journal of Emergency Medicine (2018),https://doi.org/10.1016/j.ajem.2018.02.029
Med Dec 7 2017 (pii: S0735–6757(17)31004–5 [Epub ahead of print]. doi: 101016/ jajem201712.016).
[4] Bielski K, Smereka J, Ladny JR, Szarpak L. A comparison of the Macintosh laryngoscope and blind intubation via I-gel in intubating an entrapped patient: a randomized cross-over manikin study. Am J Emerg Med May 2017;35(5):787–9.https://doi.org/10. 1016/j.ajem.2016.11.048.
[5] Kurowski A, Hryniewicki T, Czyżewski L, Karczewska K, Evrin T, Szarpak Ł. Simulation of blind tracheal intubation during pediatric cardiopulmonary resuscitation. Am J Respir Crit Care Med Dec 1 2014;190(11):1315.https://doi.org/10.1164/rccm. 201409-1635LE.
[6] Ladny JR, Bielski K, Szarpak L, Cieciel M, Konski R, Smereka J. Are nurses able to per-form blind intubation? Randomized comparison of I-gel and laryngeal mask airway. Am J Emerg Med May 2017;35(5):786–7.https://doi.org/10.1016/j.ajem.2016.11.046. [7] Smereka J, Szarpak L, Ladny JR. The LMA Fastrach® as a conduit for endotracheal in-tubation during simulated cardiopulmonary resuscitation. Am J Emerg Med Jul 2017; 35(7):1020–1.https://doi.org/10.1016/j.ajem.2017.01.013.
[8] Smereka J, Ladny JR, Naylor A, Ruetzler K, Szarpak L. C-MAC compared with direct lar-yngoscopy for intubation in patients with cervical spine immobilization: a manikin trial. Am J Emerg Med Aug 2017;35(8):1142–6.https://doi.org/10.1016/j.ajem.2017. 03.030.
2 iGEL vs laryngeal tube for airway management during a normal airway scenario
Please cite this article as: Evrin T, Madziala M, iGEL vs laryngeal tube for airway management during a normal airway scenario, American Journal of Emergency Medicine (2018),https://doi.org/10.1016/j.ajem.2018.02.029
