Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: a feasibility study

Benger, Jonathan; Coates, D.; Davies, S.; Greenwood, Rosemary; Nolan, Jerry P.; Rhys, Megan; Thomas, Matthew; Voss, Sarah

doi:10.1093/bja/aev477

Cited by 52 publications

(51 citation statements)

References 32 publications

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“…[1314] A number of randomized clinical trials and a meta-analysis also reported that OLP between i-gel™ and LMA-S™ is similar. [678915] On the contrary to our findings, Chew et al . and Ragazzi et al .…”

Section: Discussioncontrasting

confidence: 99%

“…[5] Although a number of randomized controlled trials and a meta-analysis have compared i-gel™ and LMA-S™ in adult patients and found that both the device provided equivalent oropharyngeal leak pressure (OLP). [6789] After reviewing the literature, we did not found any study till now that has compared air-Q™ with either of these two devices in adult patients. Jagannathan et al .…”

Section: Introductionmentioning

confidence: 99%

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Comparison of oropharyngeal leak pressure of air-Q™,i-gel™, and laryngeal mask airway supreme™ in adult patients during general anesthesia: A randomized controlled trial

et al. 2017

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Study Objective:Various randomized controlled trials and a meta-analysis have compared i-gel™ and laryngeal mask airway Supreme™ (LMA-S™) in adult patients and found that both the devices provided equivalent oropharyngeal leak pressure (OLP). However, no randomized controlled trial has compared air-Q™ with i-gel™ and LMA-S™ in adult patient. Hence, we designed this study to compare air-Q™ with LMA-S™ and i-gel™ in adult patients.Materials and Methods:A total of 75 adult patients of the American Society of Anesthesiologists physical status I/II of both sexes, between 18 and 60 years, were included in this prospective randomized controlled trial conducted in a tertiary care center. Randomization of patients was done in three equal groups according to the insertion of supraglottic airway device by a computer-generated random number sequence: group air-Q™ (n = 25), group i-gel™ (n = 25), and group LMA-S™ (n = 25). Primary outcome of this study was OLP. We also recorded time for successful placement of device, ease of device insertion, number of attempts to insert device, and ease of gastric tube insertion along with postoperative complications.Results:The mean ± standard deviation OLP of air-Q™, i-gel™, and LMA-S™ was 26.13 ± 4.957 cm, 23.75 ± 5.439 cm, and 24.80 ± 4.78 cm H2O (P = 0.279). The first insertion success rate for air-Q™, i-gel™, and LMA-S™ was 80%, 76%, and 92%, respectively (P = 0.353). The insertion time of air-Q™, i-gel™, and LMA-S™ was 20.6 ± 4.4, 14.8 ± 5.4, and 15.2 ± 4.7 s, respectively (P = 0.000). Time taken for air-Q™ insertion was significantly higher than time taken for i-gel™ (mean difference 5.8 s, P < 0.0001) and LMA-S™ (mean difference 5.4 s, P = 0.0001) insertion. Postoperative complications were similar with all three devices.Conclusions:We concluded that air-Q™, i-gel™, and LMA-S™ were equally efficacious in terms of routine airway management in adult patients with normal airway anatomy.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of oropharyngeal leak pressure of air-Q™,i-gel™, and laryngeal mask airway supreme™ in adult patients during general anesthesia: A randomized controlled trial

et al. 2017

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“…33-35 However, at least 3 currently ongoing randomized phase 3 trials are assessing advanced airway management during cardiac arrest in the out-of-hospital setting (clinicaltrials.gov identifiers NCT02419573 and NCT02327026 and isrctn.com identifier ISRCTN08256118). While these trials assess the efficacy of advanced airway management in the out-of-hospital setting, the results might not translate to the in-hospital setting given important differences in cardiac arrest etiology, skills of health care professionals, and timing of interventions.…”

Section: Discussionmentioning

confidence: 99%

Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival

Andersen

Granfeldt

Callaway

et al. 2017

JAMA

171

133

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IMPORTANCETracheal intubation is common during adult in-hospital cardiac arrest, but little is known about the association between tracheal intubation and survival in this setting.OBJECTIVE To determine whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. DESIGN, SETTING, AND PARTICIPANTSObservational cohort study of adult patients who had an in-hospital cardiac arrest from January 2000 through December 2014 included in the Get With The Guidelines-Resuscitation registry, a US-based multicenter registry of in-hospital cardiac arrest. Patients who had an invasive airway in place at the time of cardiac arrest were excluded. Patients intubated at any given minute (from 0-15 minutes) were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics. EXPOSURE Tracheal intubation during cardiac arrest. MAIN OUTCOMES AND MEASURESThe primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and a good functional outcome. A cerebral performance category score of 1 (mild or no neurological deficit) or 2 (moderate cerebral disability) was considered a good functional outcome. RESULTSThe propensity-matched cohort was selected from 108 079 adult patients at 668 hospitals. The median age was 69 years (interquartile range, 58-79 years), 45 073 patients (42%) were female, and 24 256 patients (22.4%) survived to hospital discharge. Of 71 615 patients (66.3%) who were intubated within the first 15 minutes, 43 314 (60.5%) were matched to a patient not intubated in the same minute. Survival was lower among patients who were intubated compared with those not intubated: 7052 of 43 314 (16.3%) vs 8407 of 43 314 (19.4%), respectively (risk ratio [RR] = 0.84; 95% CI, 0.81-0.87; P < .001). The proportion of patients with ROSC was lower among intubated patients than those not intubated: 25 022 of 43 311 (57.8%) vs 25 685 of 43 310 (59.3%), respectively (RR = 0.97; 95% CI, 0.96-0.99; P < .001). Good functional outcome was also lower among intubated patients than those not intubated: 4439 of 41 868 (10.6%) vs 5672 of 41 733 (13.6%), respectively (RR = 0.78; 95% CI, 0.75-0.81; P < .001). Although differences existed in prespecified subgroup analyses, intubation was not associated with improved outcomes in any subgroup.CONCLUSIONS AND RELEVANCE Among adult patients with in-hospital cardiac arrest, initiation of tracheal intubation within any given minute during the first 15 minutes of resuscitation, compared with no intubation during that minute, was associated with decreased survival to hospital discharge. Although the study design does not eliminate the potential for confounding by indication, these findings do not support early tracheal intubation for adult in-hospital cardiac arrest.

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“…Despite the scale of the 3 trials, important scientific questions remain. PART, AIRWAYS‐2, and CAAM evaluated different airway devices; there has been only 1 direct randomized comparison between different SGA devices (eg, LT, i‐gel, or LMA), and none between SGA and BVM in randomized clinical trials enrolling adult OHCA patients . There is also limited information regarding the influence of airway management technique on chest compression continuity.…”

Section: Unanswered Questionsmentioning

confidence: 99%

Endotracheal intubation during out‐of‐hospital cardiac arrest: New insights from recent clinical trials

Wang

Benger

2019

JACEP Open

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Airway management is an important intervention during resuscitation of out‐of‐hospital cardiac arrest (OHCA). Endotracheal intubation is commonly used by emergency medical services paramedics in the advanced airway management of OHCA, but numerous studies question its safety and effectiveness. Furthermore, there is now increasing use of supraglottic airway devices. In this review, we provide an overview of 3 recent randomized clinical trials of advanced airway management (Pragmatic Airway Resuscitation Trial [PART], AIRWAYS‐2, and Cardiac Arrest Airway Management [CAAM]) and highlight new information that is available to guide OHCA airway management practices.

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Randomised comparison of the effectiveness of the laryngeal mask airway supreme, i-gel and current practice in the initial airway management of out of hospital cardiac arrest: a feasibility study

Abstract: 18528625).

Cited by 52 publications

References 32 publications

Comparison of oropharyngeal leak pressure of air-Q™,i-gel™, and laryngeal mask airway supreme™ in adult patients during general anesthesia: A randomized controlled trial

Comparison of oropharyngeal leak pressure of air-Q™,i-gel™, and laryngeal mask airway supreme™ in adult patients during general anesthesia: A randomized controlled trial

Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival

Endotracheal intubation during out‐of‐hospital cardiac arrest: New insights from recent clinical trials

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