Year: 2026
Type: book-chapter
Abstract: Background. The i-gel is a single-use, second-generation supraglottic airway with a non-inflating thermoplastic cuff and a gastric channel. It is inserted blindly in seconds, requires no cuff inflation, and has become the most widely deployed supraglottic device in prehospital cardiac arrest care. Field clinicians use it as a primary airway in cardiac arrest, as a rescue device after failed intubation, and as a bridge when laryngoscopy is impractical, but the device does not protect the airway from aspiration and the manufacturer limits its recommended dwell time. Objective. To provide a graded protocol for indications, size selection, insertion, confirmation, troubleshooting, and evacuation of patients managed with an i-gel in wilderness, expedition, transport, and prolonged-field-care settings, and to correct omissions in the field-reference edition field entry. Methods. The 2020 American Heart Association adult advanced life support guideline was used as the index document for the cardiac arrest indication. PubMed/MEDLINE, the only database searched, was searched from inception to September 5, 2026 with three Boolean strings covering device performance, cardiac arrest and prehospital use, and special populations, which returned 612, 498, and 124 records respectively; randomized trials, systematic reviews, observational cohorts, and society guidelines on the i-gel and supraglottic airways in prehospital and emergency care were eligible. Grades for cardiac arrest recommendations were transcribed from the American Heart Association scheme; all other grades were assigned by the author using the American College of Chest Physicians scheme, and the few actions that cannot be graded are marked as such with the reason stated in the sentence. Recommendations. In adult out-of-hospital cardiac arrest, a supraglottic airway strategy is an acceptable alternative to tracheal intubation (Class 2a, Level B-R), and in systems with limited intubation exposure it is preferred. Size is selected by manufacturer weight band (size 3 for 30 to 60 kg, size 4 for 50 to 90 kg, size 5 above 90 kg; pediatric sizes 1 to 2.5 from 2 kg upward), with the device one size larger kept ready (1C). Placement is confirmed by waveform capnography (1C). A persistent leak with the device seated at the teeth prompts a change to the next larger size; failure to advance with the bite block proud of the teeth prompts a change to the next smaller size (2C). A gastric tube of 12 to 14 French is passed through the channel of adult sizes (2C). The expected oropharyngeal seal is about 24 to 26 cmH2O, and the manufacturer recommends the device not remain in place beyond four hours, so every patient managed with an i-gel is evacuated toward a definitive airway with continuous monitoring (1C). Conclusion. The i-gel is well supported for cardiac arrest by a large cluster-randomized trial and for elective anesthesia by observational cohorts, but its use in trauma, in prolonged transport, and in cold environments rests on extrapolation and expert opinion, and the protocol states so at each point.
DOI: 10.67999/b0002.c24
Author: Casey C. Sears
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7203885662