Successful insertion rates of the i-gel supraglottic device compared to the Smiths Soft Seal laryngeal mask airway (LMA) for out-of-hospital cardiac arrest: A randomised controlled trial

INTERVENTION: The i‐gel supraglottic airway device with non‐inflatable cuff. The device consists of a cuff made from a thermoplastic elastomer, which is designed to create a non‐inflatable anatomical seal of the laryngeal, pharyngeal and perilaryngeal structures. The connecting hard plastic tube performs as a way in which to administer oxygen to the patient in cardiac arrest. It also has an integrated bite block and gastric channel for the insertion of an intragastic tube by which to empty gastric contents. The patient will have the i‐gel in situ while they are in cardiac arrest, or if an Intensive Care Paramedic becomes available and deems it is appropriate to insert an endotracheal tube. The device is inserted into the oral cavity of patients in cardiac arrest. It is inserted by gliding the device downwards and backwards along the patients hard palate until definitive resistance is felt. The tip of the cuff sits in the oesophageal opening, and the epiglottis blocker prevents the epiglottis from occluding the tracheal opening, so that the aperture of the cuff sits over the the tracheal opening. The differences between the i‐gel and the comparator are that the comparator has an inflatable cuff, which requires the extra step of inflation after insertion. This means that it is not as rigid and the tip of the cuff has folded over as it has been inserted, not sitting in the oesophageal opening. A separate bite block is needed and there is no gastric channel to empty stomach contents, so there is a higher risk of aspiration of stomack contents. There is also a position guide on the i‐gel ‐ a line marking the optimal position for the teeth to sit if inserted correctly. CONDITION: Cardiopulmonary arrest PRIMARY OUTCOME: Bilateral breath sounds in axilla auscultated using stethoscope by paramedics Colour change in the CO2 (carbon dioxide) detector from purple to yellow Rise and fall of chest with each bag ventilation visually examined by paramedics SECONDARY OUTCOME: Ease of insertion of the device, rated by paramedic using numerical rating scale (NRS) Return of spontaneous circulation, confirmed by palpable pulse detected by paramedic INCLUSION CRITERIA: Out‐of‐hospital cardiopulmonary arrest attended to by the Ambulance Service of New South Wales (ASNSW)