Is an i-gel® supraglottic airway useful for airway rescue in the community?
To ascertain whether an i-gel® (Intersurgical UK) supraglottic airway is suitable for newborn resuscitation in the community.
Fifty five community midwives were invited to participate in this study during their continuing professional development (CPD) training time over a 4 month period. Twenty of the midwives were able to participate during this time frame. The midwives were asked to manage a newborn resuscitation scenarios using 2 differing techniques: Bag valve mask with a Guedel airway (control) and a bag with an i-gel®.
Time to first breath was quicker using the i-gel® compared to bag valve mask and Guedel airway. There was no significant difference in duration of inflation breaths between the two techniques. Participants generated higher inflation pressures using i-gel® with a mean of 40cm H2O as opposed to 34cm H2O with the bag valve mask and Guedel airway.
The time to first breath is considerably shorter using an i-gel® although airway pressures were significantly higher. Further investigation is needed before it could be recommended for clinical use, specifically to investigate the increased airway pressures and the true rate of failure.
In the UK, midwives working both in the community and the hospitals are taught a standardised approach to newborn resuscitation on the Newborn Life Support (NLS) Course (Richmond, 2011). Unfortunately, the techniques and recommended equipment for newborn resuscitation are neither always available nor practicable in the community.
Although midwives generally attend home deliveries in pairs, occasionally they are alone and two person techniques of resuscitation are not possible unless a member of the family is willing and able to help (Chua et al, 2012). A neighbouring Trust provides their community midwives with an i-gel® (Intersurgical UK), for this eventuality. As a consequence, the question was raised why this piece of equipment was not available for our own staff.
Although there has been no study supporting the use of either a Guedel oropharyngeal airway or an i-gel® in neonatal resuscitation, Guedel airways are used for airway management in newborn resuscitation and successful resuscitation of newborns has been reported using the Laryngeal Mask Airway (Schmölzer et al, 2013).
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