I gels best airway control kit ever?

Interesting bit of kit.

Looking at the videos it could be a quicker tool that ET or LMA in pre-hospital care.

Does anyone know if it has been trialled or use pre-hospital yet?
 
Gents,
The Igel is a good supraglottic airway, I use these everyday within Anaesthetics, they have been cleared by the Uk Resuscitation Council.
A few tips if your going to use these devices:

Be clearful of the lips whilst inserting the airway, the device is bulky and tends to drag the lips between the teeth.
We have stopped using KY Jelly to assist insertion, we now use normal saline, as we were finding that the airway was slipping out of position.
If your using the device in the prehospital arena, I suggest that you keep it warm !, as it becomes quite hard, and does'nt follow the anatomical curve of the airway.
Bear in mind that the cuff of the igel is a specialist polymer that expands only slightly with body heat, producing the seal.

hope that helps.

Russ
 
TacMedic1 said:
Interesting bit of kit.

Looking at the videos it could be a quicker tool that ET or LMA in pre-hospital care.

Does anyone know if it has been trialled or use pre-hospital yet?
Click to expand...
The company which I work for issues them as part of our vehicle trauma packs. We've been carrying them for over 4 months now. I personally haven't seen it used on a real casualty, but we do incorporate the use of it in to our weekly med training as a primary means of maintaining an airway in severe trauma cases.

Another excellent piece of med kit which we are now issued with is the First Access for Shock & Trauma“ (F.A.S.T.1) device.
 
Just answering Tacmedic1
Have they been trialled in pre-hospital care

They were recommended on the Pre-Hospital Emergency Care Course run by the British Association of Immediate Care Specialists

PS

I gels £9 on google shopping
 
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Starlight, I would have to correct you there. The King LT devices are not definitive airways. They are supraglottic airways, with the distal balloon (not a cuff) sitting against the oesophagus. It does a reasonable job of preventing air from being bagged into the oesophagus but does not protect 100% against fluid aspiration from the stomach. The King LT does not at any point enter the trachea or pass the chords, (like a combitube can) nor does it provide a cuffed airway beyond the chords. In fact, if by some remote chance you manage to place the King LT into the trachea, it will fully occlude the airway and will not work.
I like King LTs and find them very useful, it's a close second to a definitive airway, but you still need to be on your guard for aspiration and displacement.

Just my two pence gents, hope you are all well.

John
 
It's advertised and considered 'definative'. It's shown in clinical studies to be more effective than ET in a pre-hospital setting.

A point that is more relevant to this forum, where the majority of medics are not paramedics, is that there is no need for laryngoscopy. Therefore, it would be appropriate for non paramedics to use this item, as it only requires minimal training.

Everybody wins.

[url]http://images.google.co.uk/imgres?imgurl=http://www.kingsystems.com/Portals/1/1head-shot9psd1.jpg&imgrefurl=http://www.kingsystems.com/PRODUCTS/AirwayDevices/tabid/79/Default.aspx&usg=__omcNfnAGY8dL57bIIWsOWVoxkZQ=&h=123&w=144&sz=4&hl=en&start=6&um=1&tbnid=V5ShBMyEVYZukM:&tbnh=80&tbnw=94&prev=/images%3Fq%3Dking%2Blt%2Bairway%26hl%3Den%26rlz%3D1W1GPEA_en-GB%26sa%3DX%26um%3D1[/URL] refers

Starlight Out
 
OK, not wanting to pull this thread completely off track, but here goes;

At no point, even in the pages you have referenced is the King LTD device referred to as a definitive airway. "Superior positive pressure (than with other non-definitive airways), easy to place, 100% latex free", but not definitive.

It has not been shown to be "more effective than ET intubation in the pre-hospital setting". It has simply been shown to be easier to insert. NPA's are also easier to insert than ET intubation, does that mean that the two airways are comparible by way of quality? No.

I fully agree that all of the King devices are great for any provider who cannot RSI, or is inexperienced at ET intubation, I am happy to use them myself, but the fact remains that they are no more definitive than OPA, NPA or LMA.

Not trying to be a smart-arse here, just making sure the guys get the right info.

All the best.
 
I've taken this from the I-gel website

ET tube vs I-gel study

A number of studies, case reports and correspondence relating to the use of i-gel has already been published, but this is the first study to make a comparison of the device to cuffed tracheal tubes during pressure-controlled ventilation. In this study, published in the BJA, twenty-five patients were given a standard anaesthetic, followed by insertion of an i-gel. The lungs were ventilated at three different pressures and the difference between the inspired and expired tidal volumes used to calculate the leak volume and leak fraction. The i-gel was then removed and replaced with a conventional tracheal tube, for which similar readings were taken. The results were then compared. From the data taken, the authors concluded that, ‘compared with a tracheal tube there is no significant difference in the gas leak when using an i-gel during PCV with moderate airway pressures’.

The complete study can be obtained at Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation -- Uppal et al. 102 (2): 264 -- British Journal of Anaesthesia. Ref: Uppal V, Fletcher G, Kinsella J: Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation. BJA 2009 102(2):264-268

Impressive

ETTubes will always be the gold standard but as second best I-gels are bloody good
 
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QUOTE= I am happy to use them myself, but the fact remains that they are no more definitive than OPA, NPA or LMA.

Is that true?
OPA and NPAs are definitely not definitive airways as they don't project from gastric regurgitation and aspiration therefore I-gels are more definitive.

I-gels are routinely used in theatres and pre-hospital and that's pretty definitive for me..

When would you take out an I-gel to intubate, long term ventilation with IPPV, I don't know?

Your pre-hospital and have a casualty with an I-gel insitu, taped and fixed, so you now decide to remove it, brave man, intubated and get your definitive airway.

Would I, probably not, please tell me I should and why.

I think the word definitive means not needed to be replaced and safe, does the I-gel qualify?

I'm trained in intubation, and thankfully never needed it pre-hospital, always carry the kit. Could I stand up in count and justify my use of an I-gel; from the PHEC course and the reading of the articles I'm sure I can, and that's good enough for me.

My airway kit will now consist of: OPA, NPA, I-gels full stop.

I think this is a great piece of kit, minimal training required with maximum life saving effect.

Thanks for the great debate, exactly why I posted, to let more of our colleagues here and use this great device.
 
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My client has an elderly relative that he is frequently with, my obvious fear for this elderly member of the family is a heart attack, that my client would feel helpless to assist.
That sense of futility I wouldn't wish on anyone.
I would like to provide him with the best most up to date training that we can find, and not just a FAAWs course.
It would be all part of the young mans education anyway, something other than protection, that we are trying to provide.
Would this fall into a viable piece of kit that in association with the right training would benefit the case in hand.
I still haven't decided on the best course or who to approach as regards this section of his education.
He also works in the family group of Hotels and so would need FAAWs any way.
But I would like this aspect of his requirement to be taught seperately in addition and to the highest standard.
Whats our thoughts on all this.?
 
I believe the I-gel is one of the most important pieces of kit I've seen in years and will become pre-hospital standard practice even for paramedics.

Therefore it should be taught on any course teaching airway control adjuncts (equipment).

For an elderly client in danger of a "heart attack" my first thought would be an Automatic Emergency Defibrillator (AED).

The course for these are short half a day to a day.

You learn:
A simple resuscitation algorithm
How to do CPR
How to connect up the machine and where to place the pads on the chest

In the event of an collapse (unresponsive) you then:
Open the airway
Call for help
Start CPR
Await AED
Place pads in appropriate place, connect to AED and switch on
You then follow the instructions from the AED

If the machine recognises a shockable rhythm it delivers an appropriate shock otherwise it instructs you to continue with CPR

Very safe, that's why there in stations, shopping centres, etc.

Drawback £900 - £1000 per machine.

AEDs are very simple, very safe and save lives

All elderly VIPs should have an AED close with someone in their staff able to use it.


Hope this helps
 
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Oddjob said:
My client has an elderly relative that he is frequently with, my obvious fear for this elderly member of the family is a heart attack, that my client would feel helpless to assist.
That sense of futility I wouldn't wish on anyone.
I would like to provide him with the best most up to date training that we can find, and not just a FAAWs course.
It would be all part of the young mans education anyway, something other than protection, that we are trying to provide.
Would this fall into a viable piece of kit that in association with the right training would benefit the case in hand.
I still haven't decided on the best course or who to approach as regards this section of his education.
He also works in the family group of Hotels and so would need FAAWs any way.
But I would like this aspect of his requirement to be taught seperately in addition and to the highest standard.
Whats our thoughts on all this.?
Click to expand...

I would suggest a CPR & AED course as a first step. This can be either a Heartstart course or one provided by British Red Cross or St. John Ambulance.

If FAAW is required then do that as well. All training has value.

Caring for a family member or working in a hotel I don't see the need for much beyond this.

If you were to want more then FPOS would be next after which we start heading into the more advanced areas covered by Ambulance Tech / EMT courses which would be far beyond the needs of your client as I read it.
 
NeuralNet said:
QUOTE= I am happy to use them myself, but the fact remains that they are no more definitive than OPA, NPA or LMA.

Is that true?
OPA and NPAs are definitely not definitive airways as they don't project from gastric regurgitation and aspiration therefore I-gels are more definitive.

I-gels are routinely used in theatres and pre-hospital and that's pretty definitive for me..

When would you take out an I-gel to intubate, long term ventilation with IPPV, I don't know?

Your pre-hospital and have a casualty with an I-gel insitu, taped and fixed, so you now decide to remove it, brave man, intubated and get your definitive airway.

Would I, probably not, please tell me I should and why.

I think the word definitive means not needed to be replaced and safe, does the I-gel qualify?

I'm trained in intubation, and thankfully never needed it pre-hospital, always carry the kit. Could I stand up in count and justify my use of an I-gel; from the PHEC course and the reading of the articles I'm sure I can, and that's good enough for me.

My airway kit will now consist of: OPA, NPA, I-gels full stop.

I think this is a great piece of kit, minimal training required with maximum life saving effect.

Thanks for the great debate, exactly why I posted, to let more of our colleagues here and use this great device.
Click to expand...

NeuralNet - thanks for the comments.

Just to clarify, the comment you have quoted was made about King LT airways, not I-Gel.

In response to your other comments, I would suggest that if your patient has an airway in place that is shifting air and is providing the protection you need, then if it ain't broke, don't fix it - especially if your medevac timelines are short / relatively smooth. My argument is not that every patient requires a definitive airway, because we all know that 90% of the airways we deal with can be managed quite conservatively if we pay attention to the basic principles of airway management.

However, if your onward movement is protracted / unknown, if you are using a "non-conventional" medevac platform (use your imagination! :D), or if you have to hold on to your unresponsive patient, then it is necessary to consider whether the airway intervention currently in situ is going to be suitable for the challenges ahead. That's not being brave, it's what they pay us for.

Have a good POETS day gents.
 
Thanks

Take your point

How physically secure is an I-gel compared with an ETT?

Both require external securing with tape or a posh clamp.

The I-gel is wider to prevent twisting in situ and has additional bite protection around the teeth area.

Whereas an ETT requires an additional OPA to prevent clamping of the teeth
and occluding the tube.

ETTs remain the gold standard


Thanks
 
Just a word on the i-gel. We trialled these and binned them because they came with a disclaimer stating that they were not approved for use in resuscitation. Every paramedic had to sign a waiver stating that they accepted personal responsibility for the patient in the event that the i-gel failed. This disclaimer was not issued by our employer's but Intersurgical who manufacter the i-gel!

Needless to say that these were instantly binned! They might be used in anaesthetics but I am not using anything which the manufacturer doesn't have confidence in!

I have never used the King LTD but my American friends sing it's praises.

We practice the STEP approach in our Trust which in a nutshell means: postural, OP, NP, Laryngeal airway and then intubation only if all other methods are failing to maintain the airway. This means our paramedics are becoming deskilled and our patients are receiving a substandard airway and all because a small group of anaesthetists feel threatened by anyone else practising 'their' skill!

I would happily use the King LTD but not the i-gel regardless of what anyone says, that waiver was enough to put off all of our paramedics and our medical director.
 
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