I gels best airway control kit ever?

ukparamedic said:
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....Needless to say that these were instantly binned!
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Glad I haven't purchased any yet... If the manufacturer wants a waiver signed for the kit they sell I am suprised they manage to sell any. Has this been made common knowledge to all the trusts etc?

postural, OP, NP, Laryngeal airway and then intubation only if all other methods are failing to maintain the airway.
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OP before NP?

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!
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During my last set of clinicals I was lucky enough to be in an A&E and Theatre where I was asked "what do you want to see, learn or do?" so got to do plenty of not just airways and canulations but got hands on experience of every aspect of these departments for about 2 months. This included many RSIs :eek: which surprised me.. I think it depends on which gas man you get for training...
 
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Hi again Guys, further to my last, where the matter of whether the King LTD is definitive or not, I've had this back from the supplier. Names have been removed.

Hi C**********

Sorry for the delay in replying.

I can confirm this is a definitive airway adjunct, all answers to your questions are in the attachments.

If you are having problems opening any of these please let me know and I can send you a CD.

Kind Regards, R****

I will now get back to my supplier, and ask consent to put his contact details in clear. For those that are interested, and on production of your med quals (to them not to me), I'll try to negotiate a CPW discount with the supplier.

I'll keep you all posted,

Starlight Out
 
This was the pre-sample email from Intersurgical sent to our firm:

"I have arranged for the catalogue to be sent to you. However, with regard to the samples of the i-gel, I just wish to confirm that the i-gel has not been verified for use in resuscitation, and therefore if you wish to use it for such this would be your decision, and you would take full responsibility.Please confirm before I send the samples out you are happy with the above."

We also had to sign a waiver which none of us were happy with. You may email intersurgical directly to confirm the above.

OP before NP? Yes, an OP always comes first as it is a basic airway manoeuvre and is almost considered postural.
 
ukparamedic said:
This was the pre-sample email from Intersurgical sent to our firm:

"I have arranged for the catalogue to be sent to you. However, with regard to the samples of the i-gel, I just wish to confirm that the i-gel has not been verified for use in resuscitation, and therefore if you wish to use it for such this would be your decision, and you would take full responsibility.Please confirm before I send the samples out you are happy with the above."

We also had to sign a waiver which none of us were happy with. You may email intersurgical directly to confirm the above.
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I'll pass this on to a few people who would be very interested in this..;)

OP before NP? Yes, an OP always comes first as it is a basic airway manoeuvre and is almost considered postural.
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I was thinking about introducing an OP to a concious patient with gag reflex wasn't such a good idea.. and could be messy. It's been a long day so wierd thoughts and ideas should be expected :D
 
29 July 2009
Intersurgical is delighted to confirm its revolutionary single use, supraglottic airway, i-gel, is now indicated for use in resuscitation as well as in anaesthesia.

i-gel was launched in 2007 and has since become the supraglottic airway of choice in many hospitals in the UK, Europe and across the world. The rapid and easy insertion, improved safety provided by the gastric channel, low post-operative complications and high seal pressures, provide benefits to both clinician and patient1.

A number of case reports and clinical studies have since highlighted the potential advantages i-gel offers in the resuscitation scenario2,3,4,5, where seconds can make all the difference. With its unique, soft, non-inflatable cuff, valuable time is not wasted deflating and inflating a cuff. This allows a patent airway to be established in the quickest possible time. In many cases, insertion can be achieved in less than 5sec6.

For personnel suitably trained and experienced in the use of airway management devices and advanced life support techniques, i-gel now offers a new and exciting option for establishing a patent airway during resuscitation of the unconscious patient.

References:

1. Richez B, Saltel L, Banchereau F, Torrielli, Cros AM: A new single use supraglottic airway with a noninflatable cuff and an esophageal vent: An observational study of the i-gel: Anesth Analg. 2008 Apr;106(4):1137-9.

2. Gatward JJ, Thomas MJC, Nolan JP, Cook TM: Effect of chest compressions on the time taken to insert airway devices in a manikin: Br J Anaesth. 2008 Mar;100(3):351-6.

3. Gabbott DA, Beringer R: The i-gel supraglottic airway: A potential role for resuscitation?: Resuscitation. 2007 Apr;73(1):161-2.

4. Soar J: The i-gel supraglottic airway and resuscitation - some initial thoughts: Resuscitation. 2007 Jul;74(1):197.

5. UK Resuscitation Council Advanced Life Support Guide (5th Edition). Revised June 2008.

6. Bamgbade OA, Macnab WR, Khalaf WM: Evaluation of the i-gel airway in 300 patients. Eur J Anaesthesiol. 2008 Oct;25(10):865-6.
 
Quite recently approved then, when we were issued with them they weren't approved so obviously my information is a bit older than the link posted above. It seems from the date that they have only been approved for a couple of months. I would still be reluctant to use one given my previous experience. That's a personal decision though.
 
Paramedic tracheal intubation can no longer be recommended as a mandatory component of paramedic practice

A Critical Reassessment of Ambulance Service Airway Management in
Pre-Hospital Care
JRCALC Airway Working Group
June 2008

Paramedic tracheal intubation has been practiced in the UK for more than 20 years and is currently a core skill for paramedics. Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcome. There is also evidence that the current initial training of 25 intubations performed in-hospital is inadequate and that the lack of ongoing intubation practice may compound this further. Supraglottic airway devices (SADs; e.g. laryngeal mask airway), that were not available when extended training and paramedic intubation was first introduced, are now in use in many ambulance services and are a suitable alternative pre-hospital airway device for paramedics.

The Committee concluded that paramedic tracheal intubation can no longer be recommended as a mandatory component of paramedic practice and should not be continued to be practiced in its current format. If pre-hospital tracheal intubation is to be undertaken, it requires considerably more education and training than that currently provided for paramedics or the use of physicians with appropriate training in advanced airway skills. SADs are suitable alternatives to tracheal intubation.

SADs should be introduced into all ambulance services and ambulance trusts should ensure that both paramedics and technicians receive adequate initial and ongoing training in the use of these devices.
 
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That information has been completely debunked by the BPA and it was proven that the doctor behind it has a conflict of interests. There is also a wealth of evidence that this doctor has for ten years been trying to de-skill paramedics. Paramedic intubation is still being practised and there is a full and legitimate study being undertaken by JRCALC.

The information posted above was conducted by a doctor based on studies from the 1960s, neither of the studies were on UK paramedics and neither of them were even based on pre-hospital intubation!
 
Agreed UKP, it's been doing the rounds for a while now, and has absolutely no credibility. It's been completely discredited by almost every independant review.

I know of another nobber of a doc (T***q Q*****i). Works somewhere around Oxford I think. Seems to spend an inordinate amount of his time trying to remove intubation from the para skills base. At least he did last time I accidentally bumped into him at a seminar.

He's an anesthetist with an agenda - and I suspect it's nothing to do with patient care or survivability and more to do with sponsorships, freebees and product sales. What a tool.

Given his attitude, I just had to wind him up a bit - rude not to really. So I steered the conversation towards the current RSI discussion. I thought he was going to have a fookin baby when I said that it was on the agenda for paras. Couldn't resist and funny as fook.

Starlight Out
 
Pitchblack said:
Maybe I've missed the point, but at the end of the day, who has time to insert anything other than a nasal or oral pharyngeal?
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:confused:

An OP or NP is not a definitive airway.

If the insertion of an advanced airway adjunct, LMA iGel ET Combi etc, is required then there is always time.
 
The only definitive airway is an ET. Thats the way it is.
Whether you use an KING LD or a combitube, NEITHER of them pass the vocal cords, and are therefore not considered a definitive airway by ERC, DASAIM or any other anaestethic society.

The LD is a newer version of the combitube. Each has its advantages, but in my bag, there are ET and LDs, and no combitubes. The combitubes could come into play if you needed goood gastric control, i.e. in upper GI bleeding, varices in the oesophagus or similar incidents, where you need to be able to place a gastric tube as well. The LD doesnt allow for that.

Just my 5 cents
 
DrMikeM said:
The only definitive airway is an ET. Thats the way it is.
Whether you use an KING LD or a combitube, NEITHER of them pass the vocal cords, and are therefore not considered a definitive airway by ERC, DASAIM or any other anaestethic society.

The LD is a newer version of the combitube. Each has its advantages, but in my bag, there are ET and LDs, and no combitubes. The combitubes could come into play if you needed goood gastric control, i.e. in upper GI bleeding, varices in the oesophagus or similar incidents, where you need to be able to place a gastric tube as well. The LD doesnt allow for that.

Just my 5 cents
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Any EBM to support that statement?

Maybe you should mention this to the manufacturers of these adjuncts then, as they're obviously either deluded or lieing :rolleyes:
 
Bare with me on that one.

I'm doing a course this coming week on RSI and advanced airway management. I'll make a point of asking for a definitive answer including supporting EBM documents and publish here.
 
I recently attended a course where I was introduced to the i-gel. It appeared easier, quicker and more effective than an LMA (I have never been fond of LMA's).


I feel the i-gel certainly has a place in pre hospital care and is another valuable airway option. It was interesting to see insertion done whilst ECC where being continuously performed during an arrest scenario. ​



I agree that ET is still the gold standard in airway management. Also I noted that drug administration was not indicated via the i-gel, unlike ET tubes. I was advised on the course that an ET tube could be blindly inserted through an in situ i-gel. I am yet to fully look into and practice that though.​



From an operational stand point where there are often limited operators with EMT training/experience and transport/time critical patients; its a good thing. I think it will add a new skill and capability for EMT B/I in airway management. ​



NP/OP have a role, but I always attempt to apply best practice if it does not mean compromising the patient and lead to deterioration; ie if the circumstances and time permit secure the airway with an ET.​



I have refresher training on the Emergency Airway Management Course at Singapore General Hospital next month. I will take an i-gel and speak to the staff there and see what their opinion is. ​



In summary, the i-gel is quick, easy to use, and easy to teach……. I rate it.​
 
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Starlight said:
Looks like a reworked LMA. My understanding is that is still not considered a definative airway.

Try the King LTD instead. Already used pre-hospital and is a definitive airway.
[url]http://www.kingsystems.com/PRODUCTS/AirwayDevices/KINGLTD/tabid/55/Default.aspx[/URL] refers
Looks like a combitube but isn't.

Starlight Out
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I completely agree w/ Starlight and after googling the product it does state that it is in fact an LMA, Laryngeal Mask Airway... or Let Me Aspirate.... Yes they work great in anesthesiology, where things are elective and Pt's typically have empty gastric contents... but last time I ran a CODE or did an RSI in the field my Pt didn't read the textbook and had eaten w/ in the previous 12hrs...
I do also recommend the King LT airway as an ET back up or a front line airway in a down and dirty environment. If you dont need to definitively secure the airway then a BVM will suffice...
Thanks all...
 
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