When you arrive at the scene of a cardiac arrest, time is critical.
Compressions should start as soon as possible and any interruption to those compressions
or, 'no flow time', should be kept to an absolute minimum.
It is therefore essential that the airway device is easy rapid and reliable to insert.
i-gel is a supraglottic airway with a non-inflatable cuff, gastric channel and other features make
it an ideal choice for out of hospital cardiac arrest in comparison to more traditional devices.
One area of particular importance is the speed and ease of insertion.
Unlike a laryngeal mask, there is no need to deflate an i-gel cuff prior to placement
or inflate after insertion.
This is because the non-inflatable gel-like cuff is specially designed to mirror the anatomy
over the laryngeal inlet.
One recent independent study has shown i-gel to be 50% faster to insert than the other
devices tested including an ET tube Proseal and classic LMA.
i-gel could also be inserted during chest compressions.
Another common concern during CPR is regurgitation and aspiration.
To help combat this i-gel incorporates a gastric channel which has three primary functions.
Firstly, it provides an early warning of regurgitation, as regurgitant fluid will be seen coming up
the gastric channel, allowing appropriate action to be taken.
Secondly, a suction tube can be passed down the gastric channel to allow emptying of fluid
from the stomach.
And thirdly, excess air in the stomach is vented through the gastric channel, reducing
the risk of regurgitation.
Seal pressure is also important in CPR as the patient will often require a high airway
pressure to enable adequate ventilation.
i-gel's anatomically shaped cuff accurately positions itself over the laryngeal framework,
providing a superior seal to that of a standard laryngeal mask.
Stability is important for out of hospital CPR as the patient may be in an awkward position
and need to be moved.
The i-gel's buccal cavity stabiliser aids this in two ways.
It naturally adapts its shape to the oropharyngeal curvature of the patient...
...and resists rotation.
The i-gel O2 resus pack includes a modified i-gel with a supplementary oxygen port, a
sachet of lubricant, a suction tube and an airway support strap, all contained within
a sterile pack.
We will now run through the use of i-gel O2 resus pack in a cardiac arrest scenario.
First decide on the most appropriate size of i-gel O2 to use.
Correct size is normally determined by weight, Open the i-gel O2 resus pack, remove the inner
tray containing the lubricant, airway support strap and suction tube, and place the contents
to one side within easy reach.
Place a small bolus of lubricant on the base of the inner side of the main shell of the
packaging.
Touching no lower than the bite block of the i-gel O2 lubricate the back, sides and front
off the cuff with a thin layer of lubricant.
Ensure any excess is removed.
Grasp the lubricated i-gel O2 firmly along the integral bite block.
The ideal patient position for insertion is with the head extended and the neck flexed,
but if this is not possible or is inappropriate for the patient, then i-gel O2 can be inserted
with the head in a neutral orientation.
A proficient user can achieve insertion of i-gel in less than 5 seconds.
Introduce the leading soft tip into the mouth of the patient in a direction towards the
hard palate.
It is not necessary to insert fingers into the patients mouth
Glide the device downwards and backwards along the hard palate with a continuous but gentle
push until a definitive resistance is felt.
Do not apply excessive force.
The tip of the airway should be located into the upper oesophageal opening
the cuff should be located against the laryngeal framework.
The epiglottis should be held in place by the epiglottic rest.
The gastric channel should open into the oesophagus And the incisors should be resting on the
integral bite-block.
The i-gel O2 should now be secured in place with the airway support strap - or taped down
from 'maxilla to maxilla'
To use the airway support strap, slide it under the patients neck and secure it to the
i-gel O2 hook ring using appropriate holes on the strap.
Ensure there is sufficient tension to hold the i-gel O2 securely in place, but not excessive
tension that may cause trauma to the patient.
Some adjustment of the strap may be needed.
A resuscitation bag can then be connected to the i-gel and ventilation can begin.
If your resuscitation protocol incorporates chest compressions in combination with passive
oxygenation rather than positive pressure ventilation, the supplementary oxygen port
provides an easy and effective method for delivering oxygen passively to the lungs.
To use the supplementary oxygen port, remove the cap from the oxygen port and connect one
end of a standard oxygen tube to the port and the other end to a suitable method of
oxygen delivery and set to the oxygen flow shown in the instructions for use.
When treatment has finished, turn off the oxygen supply, remove the oxygen tubing from
the i-gel O2 and replace the port cap.
When i-gel O2 is being used conventionally, it is important that the supplementary oxygen
port remains closed.
If required a suction tube can be passed down the gastric channel to empty the stomach contents.
To use the suction tube, place a small bolus of lubricant over the proximal end of the
gastric channel, insert the suction tube a short way down the gastric channel and move
it up and down to prime before feeding the tube down.
Many independent studies have evidenced the easy and rapid insertion, high seal pressures
and improved safety offered by i-gel.
And it is now included in the European Resuscitation Council Guidlines.
The i-gel O2 Resus pack Stay focused on what matters