I-gel as a first-line airway device in the emergencyroom for patients with out-of-hospital cardiac arrest

Aim. The optimal method for advanced airway management during cardiac arrest remains controversial. Most patients with out-of-hospital cardiac arrest (OHCA) in Korea are managed with a bag-valve mask by paramedics, while physicians perform advanced airway management in emer-gency departments (ED). Endotracheal intubation (ETI) has a risk of failure at the first attempt. By contrast, I-gel, a supraglot-tic airway device, is easier to insert than an endotracheal tube and shows a higher first-attempt success rate than ETI in out-of-hospital settings by paramedics in the United States. We reviewed the use of ETI and I-gel by ED physicians to assess the first attempt success rate in a hospital setting. Methods. We conducted a retrospective chart review of patients with non-traumatic OHCA who were managed with either ETI using a Macintosh laryngoscope, or I-gel in the ED of Korean hospital from January 2012 to January 2014. 

Results. Of 322 adult patients with non-traumatic OHCA, 160 received I-gel and 162 received ETI. The first-attempt success rate was higher in the I-gel group (96.9%) than in the ETI group (84.6%, p < 0.001). The time from arrival to obtaining ad-vanced airway management was shorter in the I-gel group than in the ETI group. Conclusions. I-gel showed a better first-attempt success rate and shorter insertion time compared with ETI when performed by physicians in a hospital setting.

airway management, laryngeal mask, out-of-hospital cardiac arrest, resus-citation

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