References
A mannequin study comparing suitability of the i-gelTM with a laryngeal mask airway device
Abstract
Objectives: To compare the suitability of the i-gelTM (Intersurgical Ltd, UK) supraglottic airway device with a single-use laryngeal mask airway (LMA) in the hazardous area response team (HART) environment and the urban search and rescue (USAR) environment. Method: five chemical, biological, radiological and nuclear trained urban search and rescue paramedics attempted five insertions of each supraglottic airway device into a Laerdal® ALS mannequin (Laerdal, Norway) in three separate environments: normal (supine, waist high), HART (wearing gas-tight suits and respirators) and USAR (in a simulated confined space). As a control group, five anaesthetists also attempted five insertions of each supraglottic airway device into a Laerdal® Airway Trainer (Laerdal, Norway) under normal conditions. Time from first touching the device to successful inflation of the mannequin's lungs’ using a self-inflating bag-valve device was recorded and operator opinion was captured using a four-point Likert scale. Results: insertion of the i-gel airway was significantly faster than insertion of the LMA in simulated USAR conditions (
The confined spaces and restricted access to patients in the urban search and rescue (USAR) environment dictate the need for a supraglottic airway device (SAD) which may be easily inserted, potentially single-handed, with only limited access to the patient's head. The laryngeal mask airway (LMA) has been widely used in the prehospital environment but requires inflation of the cuff, using two hands after insertion, before it can be effective. Given the specific features of the i-gelTM airway (Intersurgical Ltd, UK), it is possible that this device is more suited to this environment.
Chemical, biological, radiological and nuclear (CBRN) incidents are currently approached using a major incident management model. This assumes there are mass casualties and dictates that anyone who is not breathing spontaneously following appropriate airway manoeuvres is effectively dead (Advanced Life Support Group, 2002). Airway management in this environment, therefore, has never been an issue. It is possible that non-terrorist radiation or chemical incidents may involve only a small number of casualties and major incident standard practices would be inappropriate if used.
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