Abstract
Introduction
The i-gel supraglottic device has a high rate of successful placement and is fast, and novice users can be easily trained to use it. There is sparse literature on prehospital i-gel failures.
Objective
To present 2 cases of unsuccessful i-gel use in Yosemite and a focused literature review.
Methods
Electronic medical record and provider recall of cases.
Results
A 67-y-old male rafter, weighing an estimated 90 kg, was pulled from a river in cardiac arrest from a suspected drowning. Size 4 i-gel had an unsuccessful seal. Size 3 i-gel replacement also demonstrated air leak. The patient was endotracheally intubated. Cardiopulmonary resuscitation was terminated in the field.
A 33-y-old female hiker, weighing an estimated 100 kg, sustained a witnessed syncopal event with no respiratory effort and a weak tachycardic pulse on rescuer arrival. Size 4 i-gel was placed. Air leak occurred unless the device was actively held in position. To continue rescue operations, the patient was endotracheally intubated. The patient subsequently lost pulses. Due to rescuer safety, resuscitation efforts were ceased in the field. Prehospital literature is limited to 1 letter to the editor and 1 case report. The case report, describing a drowning victim, reported i-gel placement with difficult ventilation and nonvisible chest movement. The letter to the editor reported 58% inadequate i-gel ventilation, defined as the ability to generate visible chest rise. Despite the device appearing to be seated correctly on those occasions, there was an audible air leak, and the airway was subsequently secured with a tracheal tube. The remainder of the i-gel literature is in definitive care settings.
Conclusions
Following cardiac arrest, the pressure required to ventilate the lungs adequately may exceed the seal pressure of the i-gel. Systematic review of supraglottic device failure in the setting of prehospital cardiac arrest is warranted. Sparse evidence exists on i-gel failures in wilderness settings, also warranting further investigation.
Keywords: i-gel, supraglottic, prehospital, wilderness, airway management