Comparing the First-Pass Success Rate of the King LTS-D and the i-gel Airway Devices in Out-of-Hospital Cardiac Arrest

Abstract

Objectives: Significant heterogeneity exists internationally in the airway devices used in the pre-hospital setting during cardiac arrest. This study evaluated the first-pass success (FPS) rate of two supraglottic airways (SGAs) used by paramedics during out-of-hospital cardiac arrest: the King LTS-D and the i-gel. Methods: By examining 2,680 patient care records compiled by Ambulance New Brunswick between 2015 and 2020, we evaluated the FPS rate of the two SGAs using a 2x2 Pearson chi-square test for association, and a Mann-Whitney U test, to determine whether there were significant differences in FPS rates.Results: Our study demonstrated a statistically significant association between airway devices and FPS favoring the i-gel with an FPS of 90.6% compared to a 76.6% FPS with the King LTS-D; X 2 (1) = 96.01, p < 0.001. The odds of successfully inserting the airway on the first attempt were 2.94 times higher if paramedics used the i-gel than if they used the King LTS-D with a 95% CI [2.32, 3.60]. Mann-Whitney's U test for SGA differences favored the i-gel in fewer attempts for successful insertion (z = -4.357, p < 0.001, d = 0.15).Conclusions: Among patients in New Brunswick with out-of-hospital cardiac arrest, paramedics had a higher FPS rate with the i-gel compared to the King LTS-D. Our study also found a statistically significant difference between the King LTS-D and i-gel, favoring the i-gel in fewer attempts. Our findings suggest that the i-gel provides a more consistent FPS rate compared to the King LTS-D within our study populations; however, further research is necessary to determine the clinical implications of this. While multiple attempts at tracheal intubation are associated with negative clinical outcomes, no such evidence exists for SGAs.

The i‐gel® supraglottic airway device compared to endotracheal intubation as the initial prehospital advanced airway device: A natural experiment during the COVID‐19 pandemic

“…retrospectively compared i‐gel ® to the King LT, with a higher (90.6% vs. 76.6%) first‐pass success rate. 18 In a randomized controlled prehospital airway trial from Australia, i‐gel ® was found to have a higher successful insertion rate (90%) in comparison to the first‐generation SGAs (57%). 19 In the AIRWAYS‐2 trial, 1523 paramedics randomized 9296 patients with OHCA to ETI versus the i‐gel ® SGA and found no significant differences in favorable functional outcome between ETI (6.8%) and i‐gel ® (6.4%).…”

“…In 2022, Price et al. retrospectively compared i‐gel ® to the King LT, with a higher (90.6% vs. 76.6%) first‐pass success rate 18 . In a randomized controlled prehospital airway trial from Australia, i‐gel ® was found to have a higher successful insertion rate (90%) in comparison to the first‐generation SGAs (57%) 19 .…”

“…There is a growing body of evidence to suggest that SGA placement is non‐inferior to ETI in the prehospital setting as first‐line airway management for non‐traumatic respiratory failure or cardiac arrest 12–15 . A second‐generation SGA, the i‐gel ® , has been proven to be simple and effective in the prehospital setting 16–19 . In the AIRWAYS‐2 trial, 9296 patients with OHCA were randomized to either i‐gel ® SGA or ETI and favorable neurologic outcome at 30 days was no different between the two techniques 12 .…”

“… 12 , 13 , 14 , 15 A second‐generation SGA, the i‐gel ® , has been proven to be simple and effective in the prehospital setting. 16 , 17 , 18 , 19 In the AIRWAYS‐2 trial, 9296 patients with OHCA were randomized to either i‐gel ® SGA or ETI and favorable neurologic outcome at 30 days was no different between the two techniques. 12 These data suggest that the i‐gel ® SGA is, at minimum, non‐inferior to ETI in prehospital airway management.…”

Comparison of fiberoptic intubation using i-gel® Plus and standard i-gel® : A Thiel-embalmed cadaveric study

“…It has a characteristic non-in atable cuff that can change its shape according to body temperature and provide a better t for individual patients after insertion [9,10]. Additionally, the standard i-gel® has a high rate of successful insertion on the rst attempt and a low incidence of blood stains caused by airway injury [11,12]. Therefore, it has been widely used in various situations, including laparoscopic surgery and prone positioning [13,14].…”