PCP requires completion of AIME BLS II and CPD 2019 for use outside of cardiac arrest
Introduction
The iGel supraglottic airway device is a tool used to provide a higher degree of airway protection that can be obtained through the use of a pharyngeal airway. It transfers the working interface between the bag-valve mask from the face to the laryngeal inlet. Paramedics may use supraglottic devices in the setting of cardiac arrest, or in patients who are obtunded and breathing spontaneously.
Indications
Supraglottic airway devices may be placed in patients who are unable to protect their airways due to a decreased level of consciousness.
Primary care paramedics who have not completed AIME BLS II and CPD 2019 may only use supraglottic airway devices in cardiac arrest.
Contraindications
Inability to place device due to difficulties with mouth opening
Known or suspected pathological or foreign-body airway obstruction
Trauma to the trachea, neck or oropharynx
Caustic ingestion
Active vomiting
Relative: Anticipated requirement for high inspiratory pressures during ventilation
Procedure
Select an appropriately-sized supraglottic airway and remove it from its packaging and its cradle. EGD sizing is based on patient weight.
Place lubricant on the cradle. Lubricate the supraglottic airway on all sides, taking care to avoid the lumen.
Open the patient’s mouth and introduce the soft tip towards the hard palette
Allow the supraglottic airway to glide along the hard palette and advance the device until resistance is felt.
Confirm placement by ventilating using a bag-valve mask
Secure the supraglottic airway using tape or a commercial tube holder
If it becomes necessary to remove a supraglottic device:
Where possible, raise the patient to a semi-recumbent position (30°)
Prepare suction, bag-valve mask, and oxygen delivery devices
Cut or remove ties or tube holders
Ask the patient to take a deep breath, and then blow out firmly. While the patient is blowing out, pull the airway smoothly out of the mouth.
Suction the oropharynx as needed.
Monitor oxygen saturation.
Support respirations as needed.
Notes
Airway obstructions are an absolute contraindication to use of a supraglottic airway. Paramedics must, therefore, confirm they are able to ventilate the patient with a bag-valve mask prior to placing a supraglottic airway.
The supraglottic airway is a tool to solve problems relating to oxygenation and ventilation. Paramedics should apply a staged approach to airway problem solving prior to using a supraglottic airway.
PCPs may not suction down either lumen of a supraglottic device
Do not occlude the suction port of the supraglottic airway