Comparing Surf Lifeguards and Nurse Anesthetists' Use of the i-gel Supraglottic Airway Device - An Observational Simulation Study

Purpose: Using a supraglottic airway (SGA) may provide more effective ventilations compared with a mouth-to-pocket-mask for drowning victims. SGAs are widely used by nurse anesthetists but it is unknown whether surf lifeguards can use SGAs effectively. We aimed to compare the use of SGA by surf lifeguards and experienced nurse anesthetists. Materials and Methods: Surf lifeguards inserted a SGA (i-gel O-2, size 4) in a resuscitation manikin during cardiopulmonary resuscitation (CPR) and nurse anesthetists inserted a SGA in a resuscitation manikin placed on a bed, and performed ventilations. Outcome measures: time to first ventilation, tidal volume, proportion of ventilations with visible manikin chest rise, and ventilations within the recommended tidal volume (0.5-0.6 L). Results: Overall, 30 surf lifeguards and 30 nurse anesthetists participated. Median (Q1-Q3) time to first ventilation was 20 s (15-22) for surf lifeguards and 17 s (15-21) for nurse anesthetists (p=0.31). Mean (SD) tidal volume was 0.55 L (0.21) for surf lifeguards and 0.31 L (0.10) for nurse anesthetists (p<0.0001). Surf lifeguards and nurse anesthetists delivered 100% and 95% ventilations with visible manikin chest rise (p=0.004) and 19% and 5% ventilations within the recommended tidal volume, respectively (p<0.0001). Conclusion: In a simulated setting, there was no significant difference between surf lifeguards and experienced nurse anesthetists in time to first ventilation when using a SGA. Surf lifeguards delivered a higher tidal volume, and a higher proportion of ventilations within guideline recommendations, but generally ventilations caused visible manikin chest rise for both groups.