title: Higher insertion success with the i-gel supraglottic airway in out-of-hospital cardiac arrest: a randomised controlled trial.
abstract: BACKGROUND
  Since their emergence from the operating theatre over a decade ago, supra-glottic airways (SGA) have become increasingly common in the management of out-of-hospital cardiac arrest (OOHCA) with laryngeal masks (LM) the most common SGA. The proliferation of LMs in the prehospital setting has occurred despite lower than expected rates of successful insertion being reported.
  
  
  METHODS
  We conducted a single-centre, prospective parallel-group, 'open label' randomised controlled trial in subjects with OOHCA (aged greater than or equal to 12 years of age; weighing greater than or equal to 30 kg) were allocated to either the i-gel supraglottic airway (IG-SGA) or the Portex Soft Seal Laryngeal Mask (PSS-LM) within a large Australian ambulance service. Our hypothesis was that use of the IG-SGA, when compared to the Portex PSS-LM, would result in a higher rate of successful insertion in patients presenting with OOHCA. The primary outcome was successful insertion of the SGA.
  
  
  RESULTS
  There were 51 patients randomised. Subjects had an average age of 65 years and 40% were female. There were no apparent differences in key demographic characteristics between groups. The IG-SGA had a significantly higher success rate than the PSS-LM (90% versus 57%; p=0.023), resulting in a 58% greater likelihood of successful insertion than the PSS-LM (RR 1.58; 95% CI 1.11-2.24). The IG-SGA was associated with significantly lower median "ease of insertion" scores.
  
  
  CONCLUSIONS
  The i-gel supraglottic airway was associated with higher successful insertion rates in subjects with out-of-hospital cardiac arrest.
authors.affiliation: Discipline of Emergency Medicine, The University of Sydney, Camperdown, NSW 2006, Australia.
authors.forename: Paul MacConachie
authors.initials: PM
authors.lastname: Middleton
authors.affiliation: School of Science and Health, The University of Western Sydney, Campbelltown, NSW 2560, Australia.
authors.forename: Paul Michael
authors.initials: PM
authors.lastname: Simpson
authors.affiliation: School of Medicine, University of Tasmania, Rozelle, NSW 2039, Australia.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Thomas
authors.affiliation: Department of Anaesthesia, Gosford Hospital, Gosford, NSW 2250, Australia. Electronic address: drjasonbendall@gmail.com.
authors.forename: Jason Charles
authors.initials: JC
authors.lastname: Bendall
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods*; D001315:Australia; D004632:Emergency Medical Services; D005260:Female; D005931:Glottis; D006801:Humans; D007440:Intubation / Q000379:methods*; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Airway management; Controlled clinical trial; Laryngeal mask; Out of hospital cardiac arrest; Paramedics; Prehospital emergency care