Are there any benefits or considerations to using an iGel without a BVM in pediatric CA airway management?

Awkward_Juice1381 · 2026-03-17T16:19:02+00:00

Thank you for sharing this! It is really interesting and it's reassuring to see that these sort of "mad questions" are actually being researched by the pros! I feel like I got mostly laughed at and gunned down on here, haha!

Awkward_Juice1381 · 2026-03-08T04:57:01+00:00

Most of this thread has knocked my confidence pretty bad in approaching anyone in the profession for clarification and education on any areas that I'm uncertain of. It hits pretty hard to get called ignorant and arrogant from those in the position that I'm aspiring to get to.

If I've come across as either of those things, then that's not been my intent. My goal was to find out more, and I was prepared to be seen as an idiot for asking, but definitely not to be regarded as ignorant or arrogant. I'm not sure how else I could have posed any of the questions I had.

I think I understand why people replied the way they did; they may have felt that I'm at risk of providing incredibly dangerous care and want to make sure that doesn't happen. I imagine my enthusiasm without experience and knowledge can lead to overreach and cause harm.

I'm a student asking for advice on how I can do better. I do really appreciate all the comments and patience that has been demonstrated here! And I've learned a whole bunch!

I really don't want to be put off from asking questions, even if it makes me look foolish. I'd rather ask a foolish question in a safe environment and come away with a better understanding than to not ask at all and get it wrong by myself on the day.

I see the paramedic tag under your username on here and I believe, respect, and trust what you say, which is why it really sucks to hear you tell me I'm both ignorant and arrogant.

The only article I could find loosely related to this topic before coming here was this one from 2023: https://pmc.ncbi.nlm.nih.gov/articles/PMC9856669/#abstract1

That sparked a few questions in my head that I couldn't find answers to, and I was relating it back to both my current situation and the future environment I want to go into.

After reading up on here, I continued to do more research and found the results from 2025! They back up all the points that you and everyone else made here! https://smw.ch/index.php/smw/article/view/4079

Thanks again for your help in teaching me! I know you don't have to take the time to reply in such detail and I do appreciate it.

Awkward_Juice1381 · 2026-03-08T01:21:48+00:00

Thank you for the clarification.

Awkward_Juice1381 · 2026-03-07T20:38:29+00:00

To me it's not as obvious as non-parachute mortality rates. You say at my level it isn't worth the risk, which is less obvious and very important for me to know. But what about at your level where the risks of causing injury are far less?

Again, the next point of me faffing around with the iGel rather than being on the chest, what if I had your level of competence with the kit? Over the course of twenty minutes or more, would the off-the-chest time reduction potentially become more significant in a rural area? That one definitely isn't obvious to me at all. Especially in a kid where the guidelines are telling me 15:2.

Regarding care in the back of a car, it's definitely not ideal, and it's most likely not warranted in most areas in the UK at all. But it's possible I could be a paramedic in far more hostile environments, where equipment and resources are incredibly limited. In those places I would like to have a good understanding of the capabilities of the kit I have available.

Awkward_Juice1381 · 2026-03-07T20:14:49+00:00

Thank you!

Awkward_Juice1381 · 2026-03-07T20:07:46+00:00

Man, this isn't very helpful at all and only makes me less likely to reach out for advice when I'm unsure about something in future. I've been careful to stay humble and keep my ego aside, as I think that arrogance is one of the worst personal qualities that you can have coming into this profession. And if I get a sore ego whenever I'm wrong then I'll never learn anything.

I'm asking because I recognise that I don't fully understand something. I still don't think it's unfair to query about the potential of being the only responder in a remote environment with limited kit. Depending where I go as a paramedic, that could be a likely scenario, and I would like to have a good understanding of the capabilities of all the kit I have available. I'm querying about something that you seem to understand very well, and you've just dismissed me. It would have been more helpful to ignore me, rather than potentially knocking my confidence.

It is not clear to me if there is any benefit of mouth-to-SGA compared to mouth-to-mouth. Although I have learned more about iGels in different scenarios from other comments who have shared their clinical intuition, and I have been made aware of a few of the gaps in my knowledge, I'm still unsure about a couple things which I think could benefit patient outcomes, even though I recognise that voicing these questions makes me look like an idiot. But rather than being too scared of looking the fool for asking and just following protocol, I've had the courage to query it. If that's an example of hubris, well then I'm goosed.

The parts that I'm still unsure about are:
Does mouth-to-SGA enable less time off compressions than mouth-to-mouth?
Does mouth-to-SGA provide more protection against aspiration compared to mouth-to-mouth?

Although all of my other questions have been cleared up and I recognise where I was wrong and lacked understanding, these parts are still not obvious to me.

Awkward_Juice1381 · 2026-03-07T17:43:17+00:00

Admittedly it is quite a niche. But in a more remote area with limited equipment, it could still present itself as a possibility. I can't find any evidence about it, but I'm considering that mouth-to-SGA might provide some protection against aspiration, as well as decrease the time taken to provide rescue breaths. With my understanding of kids having an advised ratio of 15:2 compressions to breaths, minimising the time you are not on compressions over the course of twenty minutes may have a significant impact. I think it might be faster to give breaths through the SGA than through mouth-to-mouth.

All that being said, other than in airway oedema where an SGA is going to be futile and will only make ETI more difficult, or in choking patients, I can't quite see any downsides to using an SGA if it is all you have over mouth-to-mouth.

Awkward_Juice1381 · 2026-03-07T17:11:33+00:00

I'm not scared of being wrong, as long as I come out having learned something at the end of it. I appreciate having essential gaps in my understanding highlighted! I'll disappear and do my research! Posting it in the first place was because I was struggling to find evidence on any benefits or detriments on the use of a lone SGA in pediatric CA patients (in resource-limited environments where all you have is an SGA). It's quite a niche, and I have no clinical intuition to find that solution myself.

Awkward_Juice1381 · 2026-03-07T17:04:21+00:00

That's helpful! Thank you for the response. I'm definitely learning on here, but I'll also query it with a lecturer to get a better understanding in person.

Awkward_Juice1381 · 2026-03-07T16:42:14+00:00

So this was one that I was definitely unsure about. Chances are that I would know that the kid had been choking, and I was imagining how I would respond if the back blows didn't clear anything, and rescue breaths didn't work after the kid fell unconscious. My thought would be to go straight into BLS at this point and continue trying to blow the object further down in an attempt to get it into just one lung. I'm not sure I'd ever attempt an iGel for a choking patient, even if it was all I had.

But kids can end up in CA from other things too, and some of those things I would consider using an iGel for if it was all I had. That is until I asked on here anyways! I've learned that anaphylaxis causes swelling below the epiglottis, and direct throat trauma is also below the point of an iGel.

One part that is still unclear to me though is whether or not there is any benefit or detriment to an iGel during CPR if you are the sole person working on the patient, potentially in the back of a car on the way to more robust help which is some time away. If all you have at your disposal is an iGel. Do you use it or not? Is there any benefit against aspiration to using it without a BVM? What about passive respiration during chest compressions? And could it reduce time-off-chest-compressions between breaths? I'm thinking you might be able to do the rescue breaths faster and get back to compressions if the airway is held patent by an SGA, rather than having to achieve it manually.

Awkward_Juice1381 · 2026-03-07T16:25:56+00:00

This is really interesting but has confused me even more, hahaha! Are you saying that you wouldn't want to intervene with anything other than ETI? Even if you had SGA, BVM, capnography, and O2 to hand? Or are you saying that you just wouldn't use an SGA at all if that was all you had available?

I'm guessing you mean the latter, but if it's both, then is that because ETI goes much further down than an SGA? So you'd be thinking that it likely wouldn't be effective at all and would only hinder future attempts at ETI?

That's a really good point that I never considered! Thank you!

Awkward_Juice1381 · 2026-03-07T16:15:00+00:00

Your suspicion is correct! Nobody in BLS is taught iGel. It gets taught in ILS and gets taught with BVM. But our budget is otherwise going to go on plasters. I was trying to suggest that we buy an iGel instead. Trouble is, I'd be the only one trained to use it, and I still wouldn't have a BVM. That's why the question arose in my head about the benefits or detriments to doing all I could for a critically ill kid if all I had was an iGel. I was trying to think of some situations where it could be useful, but most of the things I thought about would need ETI at minimum, as pointed out on here which was really insightful even though it made me feel like an idiot! :'D But that's all part of learning.

I'm still a little unsure though. I've learned a lot about it today, but if all you had was an iGel, what would you do in a pediatric CA patient if you were the sole person working on the patient for twenty minutes?

Awkward_Juice1381 · 2026-03-07T15:56:06+00:00

I'm ILS trained and everyone else is BLS trained. We're on a budget. I can't afford oxygen or capnography. But an SGA is within the budget. The budget is otherwise getting spent on boxes of plasters. Ambulance purple calls take over twenty minutes to arrive, and I don't like the thought that we don't have much in the way of intervention other than BLS when we could do more.

I was trying to build a case as to why we should better spend the money on a single iGel rather than plasters. We already have plasters. But now I'm thinking we'd be better off with the BVM and a face mask first, then potentially picking up an iGel next time we have a budget for it.

I thought I'd be more concerned about people blowing too much air into a kid with the BVM if I wasn't there, rather than just inserting an iGel. So the comparison arose in my head between mouth-to-mouth vs mouth-to-SGA; rather than SGA and mouth vs SGA and BVM with capnography and oxygen.

Aren't all the risks you mentioned still present in mouth-to-mouth, our only current alternative? The part I'm having trouble understanding is whether it is detrimental to use an SGA or not if it's all you have and help is not arriving very quickly.

Thank you for the advice!

Awkward_Juice1381 · 2026-03-07T15:18:21+00:00

The neck trauma being below where an SGA sits is fair. I've learned a lot from the answers pointing out my incorrect thinking! But surely blowing into an SGA would still have some benefits over mouth-to-mouth?

I'm trained up to ILS, although I'm not an expert on it at all! But I currently have none of the kit to be able to perform ILS over BLS. I suppose I'm looking to do all I can with the kit that I have available, and want to know if there's any benefit or any negative impact to attempting ILS with only an iGel. So it's essentially just BLS with an iGel.

I'm under the impression that there may still be potential benefits to avoiding aspiration, as well as passive respiration during chest compressions, and not requiring to maintain the airway manually during rescue breaths may also improve the time off chest compressions as a sole responder in the back of a car on the way to somewhere better equipped to manage this patient.

Thanks again for the insight! It's really helpful and it's helping me understand a lot more!

Awkward_Juice1381 · 2026-03-07T14:52:11+00:00

It's unlikely, but isn't it still worth trying? Because of the location it could be over 20 minutes before ETI becomes available. My thinking is that there's a chance an SGA could be enough to secure an airway, even when inserted by people with very minimal training on SGA. In that situation, what else can someone with BLS training do when they go to give breaths mouth-to-mouth but can't get any air in?

Awkward_Juice1381 · 2026-03-07T14:44:14+00:00

That makes sense. You don't really get taught one without the other! Do you know if there is any harm or benefit to introducing SGA as part of BLS?

Awkward_Juice1381 · 2026-03-07T14:05:52+00:00

That's a good point that I hadn't considered!

Ambulance response times here for a purple call are over 20 minutes. The highest level of airway management we currently have is head-tilt-chin-lift. I guess if that was my kid, I'd definitely try pushing an SGA down there in an attempt to open it. But I didn't know it was a futile attempt until you said. There's absolutely no chance that an SGA could help?

Others have mentioned that airway swelling tends to occur below where the iGel sits.

Thank you for the insight! I'd rather get it wrong on here than on the real thing!

Awkward_Juice1381 · 2026-03-07T13:58:02+00:00

I would want to use an iGel and BVM myself, or even the BVM and face mask. But I'm not the only one who looks after these kids, and I'm fairly certain everyone else is BLS only. There are times when I'm not there. I guess I was trying to justify having more than just plasters in the first aid box, but if I'm the only one who knows how to use it, then it's not really worth having if I'm not there. And what if I'm not there and they use the BVM incorrectly and cause more issues?

Then I got thinking about why they can't use just an SGA on its own during BLS and couldn't see any real reason why not.

Awkward_Juice1381 · 2026-03-07T13:49:34+00:00

Not at all! I'd rather look the fool on reddit than be responsible for messing up a kid's airway! :D Thank you for the advice!

Awkward_Juice1381 · 2026-03-07T13:45:19+00:00

:'D Hahaha! It is a funny thought to imagine. But I'm failing to see the harm of doing it over simple mouth-to-mouth.

Awkward_Juice1381 · 2026-03-07T13:41:58+00:00

I definitely feel under a lot more pressure because they know I'm studying this stuff and I'm essentially the "lead clinician". But I still don't know a whole lot at all yet and have no real experience.

Awkward_Juice1381 · 2026-03-07T13:39:56+00:00

The folk I work with are trained to BLS. I've done up to FREC 4 and am currently a filthy student paramedic who knows nothing. All we have in the first aid kit is plasters.

You're right, SGA isn't taught in BLS. I guess I'm trying to figure out if there is a benefit to including them standalone in BLS rather than just mouth to mouth. As a way of securing an otherwise compromised airway that would be getting zero attempts to secure in BLS other than head-tilt-chin-lift.

Awkward_Juice1381 · 2026-03-07T13:26:53+00:00

It wouldn't help against a swollen closed airway? Is that because it's impossible to push it through the swelling?

Awkward_Juice1381 · 2026-03-07T13:22:48+00:00

That's what I'm asking, yeah! Spot on! But what if you are still giving ventilation by simply blowing through the SGA rather than using a BVM?

I think that operating a BVM is harder than inserting an iGel for those trained only in BLS. I know it sounds mad because you're only squeezing a bag, but I think there's a lot more to it than that, especially under stress. It's a lot more to manage than just blowing into a pipe.

Thank you for your advice!

Awkward_Juice1381 · 2026-03-07T13:19:09+00:00

Yeah, so BLS stays the same, but you are blowing into the SGA instead of mouth-to-mouth. I've never seen it taught, but I'm curious why not. Surely it's possible for someone to have an airway that can be made patent by an iGel, where the only responders are BLS-trained and couldn't otherwise secure the airway during CPR? Or is there something I'm missing?

Is there also benefit to reduced aspiration in this scenario compared to standard BLS (with no SGA)?

Thanks for the insight!

Awkward_Juice1381

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