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

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.

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.

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%).

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.