Looking for I-gel thoughts

[quikmedic]

This is my first post, so try to play nice. Just out of curiosity, who all out there is using the I-gel airways? Do you guys like them? My service did a trail run last year on a few units, due to the success rate We are now moving to replacement the combitube with them service wide.

Out of you that have used them, has anyone attempted to place a bougie through them to assist with ETT placement? Or attempt to use a BVM peep valve with them?

 

[TransportJockey]

We used them at ABQ AMR, and they were ok... we had a decent success rate, and were able to intubate through them using a bougie pretty regularly.

 

[Chewy20]

They suck for prehospital care. Move around way to much. Hoping we go back to kings soon.

 

[NomadicMedic]

We're moving to them at my service, I haven't used one on a real, non latex airway yet.

 

[TXmed]

I haven't used one yet but I've heard that it's hard to get any kind of etco2 read out

 

[CANMAN]

I have yet to use one, but I don't understand this notion for placing a rescue airway, then attempting to change out to a definitive airway in the field (for most scenarios)using a bougie etc. If you can place said device, oxygenate and ventilation, then the airway emergency is over, transport to a hospital and let them worry about it. Only agruement to that would be extremely extended transport time with high risk for aspiration. You're likely taking time away from other interventions and the transport of the patient to definitive care.

 

[quikmedic]

I have yet to use one, but I don't understand this notion for placing a rescue airway, then attempting to change out to a definitive airway in the field (for most scenarios)using a bougie etc. If you can place said device, oxygenate and ventilation, then the airway emergency is over, transport to a hospital and let them worry about it. Only agruement to that would be extremely extended transport time with high risk for aspiration. You're likely taking time away from other interventions and the transport of the patient to definitive care.

Again it was mostly just a curiosity thing. But since you asked. The protocol I've seen for it shows it to be a first line airway adjunct for all codes. An ETT can only be attempted after an I-gel has failed. Where we don't have crazy long transports 20-40mins, I can understand your point. However the swollen shut airway might disagree a little bit. My thought was more of a anaphylaxis case, or hanging which happens a shockingly large amount in our area. The question was more to see if others have tried it, or know if it works. There's no plan to use it routinely as a tool of intubation assist. But the more I know the more comfortable I will feel with it.

 

[Carlos Danger]

I don't have a lot of experience with the i-gel and I've never used one in the field, but I've used them some in OR.

The different SGA's all have pros and cons in relation to each other. Traditional LMA's are usually very secure (not quite like an ETT of course, but closer than what I think most people give them credit for) when placed properly, but can take a fair amount of finagling to get seated "just right". And they do take a fair amount of practice to be able to consistently get a really good seat quickly. They are also affected more by an individual patient's anatomy than an ETT is, and probably more than a King or Combitube.

It seems like the i-gel is catching on in EMS (as opposed to other LMA's) because it is just so easy to place. Because it conforms to the patient's anatomy better than other SGA's, technique is less important and it doesn't have to be placed precisely. The downside is that they do seem a little less secure, but with a good tape job and some caution, that shouldn't matter too much.

As for intubating "thought it" with a bougie......yeah, you can do that with any SGA, some a littler easier than others. I suppose that skill has it's place and is worth practicing, but I think in most scenarios you are better off leaving the SGA in place as long as it is working. And if the reason you are switching to an ETT is because the LMA just isn't working well, than you should probably be pulling the LMA and intubating the regular way, because if the LMA is malpositioned, then it cannot be counted on to direct the bougie where it needs to go.

If you really want a device that you can place easily and then intubate though, the Air-Q is my favorite LMA of all time - not only is it really sturdy and easy to handle and place and has a built-in bite block, but it is also specifically designed for passage of an ETT. The Fastrach is an "intubating LMA" but it's really just an LMA Classic that is slightly modified to make passing an ETT a little easier.

A moderate amount of PEEP shouldn't be a problem as long as the LMA is seated well.

 

[CANMAN]

Again it was mostly just a curiosity thing. But since you asked. The protocol I've seen for it shows it to be a first line airway adjunct for all codes. An ETT can only be attempted after an I-gel has failed. Where we don't have crazy long transports 20-40mins, I can understand your point. However the swollen shut airway might disagree a little bit. My thought was more of a anaphylaxis case, or hanging which happens a shockingly large amount in our area. The question was more to see if others have tried it, or know if it works. There's no plan to use it routinely as a tool of intubation assist. But the more I know the more comfortable I will feel with it.

Yeah fair enough. My post was just a generalized post, not directed at anyone. For codes I agree if that's what you're using then it would be the most appropriate. For the hanging and other scenario you described it wouldn't be my first choice if I thought I could successfully obtain endotracheal intubation. Where I am currently practicing we don't use backup/rescue airways as a primary device in any scenario unless we personally decide to. About the only situation I will use an LMA or King as a primary adjunct is codes.

 

[Doczilla]

They're passable at best. Half the time they turn the airway into a bloody mess. You can pass an OG tube through them though, and we get decent C02 in cardiac arrests most of the time.

The straps that come with them are garbage though. Tape the crap out of em to secure it.

 

[jwk]

I have no experience with King airways - but just about any other SGA has seemed to be no better than a good old-fashioned LMA airway. We try a lot of different ones, but always come back to the LMA-style (varying manufacturers). Why? Because it works.