Supraglottic Airways

So in this episode we’re going to have a deeper think about advanced airway management and specifically supraglottic use in the prehospital and ED environment. 

Many prehospital service have seen the removal of intubation from their scope of practice, and that’s understandably been received with mixed thoughts.

But this isn’t the end of ‘expert advanced airway care for all; in fact far, far from it… we’ve all heard people talking about ‘whacking in an i-gel’, but really utilising a supraglottic device to its maximal potential can make a huge difference to our critically unwell patients. 

We’ll be running through an overview of supraglottic devices, the evidence surrounding their use, patient selection, patient positioning and size selection, placing a supraglottic device, troubleshooting and finally ongoing ventilation with a supraglottic device.

We’d love to hear any comments or feedback you have and make sure to take a look at the references and resources below.

Enjoy!

SimonRob & James

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References

Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. The AIRWAYS-2 Randomized Clinical Trial. Benger J. JAMA. 2018

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial. Henry E. Wang, MD. 2018

Airway Insertion First Pass Success and Patient Outcomes in Adult Out-of-Hospital Cardiac Arrest: The Pragmatic Airway Resuscitation Trial. Jason A Lesnick. Resuscitation. 2020

Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial. Yu Miyazaki. J Anesth. 2012

Effect of Bag-Mask Ventilation vs Endotracheal Intubation During CardiopulmonaryResuscitation on Neurological Outcome AfterOut-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. Jabre P. JAMA. 2018

Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial.Yu Miyazaki. Journal of Anesthesia. 2015

Does prewarming of i-gel improve insertion and ventilation in anaesthetised and paralysed patients? A prospective, randomised, control trial. Reddy. Saudi J Anaesthesia. 2019

Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial. Sandeep Kumar Mishra. Anesthesiol Res Prac. 2015
i-gel™ supraglottic airway in clinical practice: a prospective observational multicentre study. L Theiler. Br J Anaesth. 2012

Airway and ventilation management during cardiopulmonary resuscitation and after successful resuscitation. Christopher Newell. Crit Care. 2018

The Resuscitation Council UK; Advanced Life Support, Ventilation

PHEMCAST; LMA

Igel; Intersurgical

i-gel Insertion Video

Course Content

10 Comments

  • Done the podcast which was as amazing as ever and done the quiz after but didn’t get the certificate??

  • In the podcast, you discuss the need to assess the SGA for air leakage (with the excellent impression from Simon). However, during resuscitations in my Trust, most paramedics are wearing respirator hoods (as part of our Level 3 PPE). The hoods make hearing in general difficult, and listening for air leaks impossible. I wonder too, that with the risk of SARS-CoV-2, is getting close enough to listen for an air leak, a good idea? What else can we look for to assess air leakage, or should we secure the SGA and hope for the best?

    Thanks for another excellent podcast!

    • Thanks for the question Mark and that’s a very good point. In the absence of being able to hear a leak the feedback gain from squeezing the BVM/mapleson then the ‘feel’ of resistance from the ventilation may give an indication, along with the relative volume you deliver from squeezing the bag with comparison to the chest movement observed.

      And thanks for the appreciation of the leak impression, I spent hours rehearsing…

  • Does this mean that paramedics are being steered away from intubation? What about managing a viable ROSC with long transport time. And drowning/hanging/airway burns?
    ROSC management is very different from arrest management and so ROSC intubation is much more controlled and planned than arrest intubation. Any thoughts? Covid concern aside.

    • Hi Keith

      Some UK services have removed intubation as part of Paramedic’s scope of practice in the UK.

      Simon

  • Great round up, tip and points of view on this topic guys.
    Personally I’ve found insertion with a laryngoscope to be very effective WRT achieving seals and is my go to. I like the mention of going up a size too, something I don’t think people consider to do.

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