Abstract Background Airway obstruction remains a leading cause of preventable death on the battlefield. Extraglottic airway devices are recommended for emergent ventilation when definitive airway management is impractical in austere and prehospital environments. Objective To compare the performance of the i-gel and King LT-D when placed by combat medics under simulated tactical conditions incorporating physical exertion and combat equipment. Materials and Methods Prospective randomized crossover study of active-duty combat medics performing a standardized react-to-contact exertion protocol while wearing full combat gear, followed by placement of both devices on a high-fidelity manikin. The primary outcome was time to successful ventilation. Secondary outcomes included first-attempt success and device preference. Results Forty participants completed the protocol. The i-gel was placed significantly faster than the King LT-D (mean difference approximately 34.6 seconds; P .001). First-attempt success (97.5% vs 87.5%) and user preference (90%) favored the i-gel. No significant difference in delivered tidal volume was observed. Conclusions Under simulated tactical conditions, the i-gel enabled faster and more reliable airway placement than the King LT-D. Its simplified, cuffless design may offer advantages under physiologic stress, supporting current guideline recommendations for frontline airway management in military and other austere environments.
Santiago Peña (Fri,) studied this question.