Paramedic i-gel® Placement and Perception of Use in Prehospital Airway Management

Abstract

Objectives: Use of supraglottic airways by emergency medical services (EMS) clinicians has increased for patients of all ages. However, data are limited on real-world use in the prehospital setting, including success rates, complications, and paramedic experience. The objective of this study was to determine frequency of successful i-gel® insertion and associated complications, and to describe paramedic perception of i-gel® use. Methods: This was a prospective study of i-gel® use in adult patients at four fire-based EMS Provider Agencies in Los Angeles (LA) County from June to September 2021. All paramedics received asynchronous and hands-on training prior to implementation. The i-gel® was indicated for adult patients in respiratory and/or cardiac arrest of any etiology, as directed by LA County protocols. Patients were included if a paramedic attempted i-gel® placement at any point. After transition of care, paramedics completed a web-based questionnaire and contacted an on-call EMS physician investigator to discuss the case. Further data were abstracted from the EMS electronic patient care record. The primary outcome was successful placement of i-gel® based on adequate ventilation post insertion confirmed with capnography. Secondary outcomes were frequency of complications and paramedic perceived ease of placement and of ventilation with i-gel® measured on a 5-point Likert scale. Descriptive statistics were reported. Results: Of the 102 adult patients, 55 (54%) were female and the median age was 69 years (IQR 53–79). The majority 91 (89%) of the patients had a paramedic impression of non-traumatic cardiac arrest. Placement was successful in 90 (88%) patients overall with 85 (83%) i-gel® insertions successful on the first attempt. Complications included: 28 (28%) cases with regurgitation/emesis, bleeding (8, 8%), hypoxia (7, 7%), and dislodgement (5, 5%). Among cases of successful i-gel® placement, the majority of paramedics rated both ease of placement and ease of ventilation as “very easy” (69% and 78%, respectively) or “somewhat easy” (23% and 9%). Conclusions: Paramedics were successful in 88% of i-gel® insertion attempts with the most common complication being regurgitation/emesis. Paramedics rated the ease of placement and ease of ventilation of the i-gel® device as “very easy” or “somewhat easy” in the vast majority of cases.