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SGAs are advanced airway devices used to facilitate ventilation without conventional endotracheal tubes [44]. Other terms commonly used to describe SGAs include “extraglottic airway,” “rescue airway,” “secondary airway,” “failed airway device,” “difficult airway device,” “salvage airway,” “alternate airway,” and “backup airway.” In current prehospital practice, EMS personnel typically reserve SGAs use for situations with failed ETI efforts, but recent reports suggest a potential primary role for SGAs, especially in the setting of cardiac arrest [45, 46]. The most common SGAs in current North American prehospital use are the i‐gel™, the laryngeal tube (LT) airway, and the Laryngeal Mask Airway (LMA™). When EMS personnel have inserted an SGA instead of endotracheal tube, they should provide advance notification to the receiving ED since the SGA may require exchange to an endotracheal tube or surgical airway, and the receiving ED may need additional time to prepare or to assemble an appropriate team [47].

i‐gel

The i‐gel (Intersurgical, Inc., Liverpool, NY) (Figure 3.7) is a single lumen tube with a soft gel cuff that sits in the posterior oropharynx and seals around the perilaryngeal structure. There is no balloon to inflate. To insert the i‐gel, first lubricate the cuff and then advance the device along the posterior pharynx until resistance is encountered. At this time, the lip line on the i‐gel should align with the lips. It is then secured using a proprietary strap. A study of over 9,000 out‐of‐hospital cardiac arrest patients showed similar outcomes between individuals treated with i‐gel compared to intubation, suggesting a role as primary airway device in this setting [48]. Sizes are available for patients from 2 to >90 kg.

Figure 3.7 i‐gel.