Evaluation Of Ambu AuraGain Supraglottic Airway Device In 80 Patients
H. L. Surgenor, A. F. McNarry, A. S. Jeffrey. NHS Lothian, Edinburgh, UK.

Introduction

Oropharyngeal leak pressures reported were generally high, with medianvalues of at least 25 cmH20 seen across all sizes (see box and whisker plot).

The 4th National Audit Project and subsequent publications have encouraged
the use of second generation supraglottic airway devices (SADs) over first
generation devices1,2. Despite several devices (e.g. the i-gel, LMA Pro-Seal
and LMA Supreme) reaching the market, there is a limited amount of data
available on their effectiveness. Ambu (Ballerup, Denmark) have recently
relaunched the AuraGain. This CE marked second generation device claims toallow the passage of a nasogastric tube, deliver high seal pressures andfacilitate tracheal intubation. Published data on its use are limited3, therefore
we report initial evaluation of the AuraGain in routine anaesthetic practice toassess how it functions as a supraglottic airway.

40353025
Oropharyngeal
Leak Pressure 20(cmH20)
15105Methods
As this was a clinical evaluation of a CE marked device used for its proper
purpose, South East Scotland Regional Ethics Service deemed that formal
review was not required. Caldicott Guardian approval was sought and theTheatre Quality Improvement team consulted. Size 3 and 4 AuraGains wereavailable initially, size 5s became available at the end of the evaluation period.
A mixed group of consultant anaesthetists used the AuraGain in adult patientsas they would any supraglottic airway in their normal clinical practice. There
were no specific exclusion criteria. Data recorded included BMI, sex, number ofinsertion attempts, oropharyngeal leak pressure (OLP) immediately afterinsertion (manometric stability method4, gas flow 5 litres min-1) and evidence of
trauma (blood visible on mask removal). As the evaluation aimed to assess
how the device functioned simply as a SAD, tracheal intubation or insertion of
nasogastric tubes via the devices were not attempted unless clinically indicated.

Results
Twenty six anaesthetists trialled 80 devices, with clinicians reporting theywould use the device again in 90% of insertions. Table 1 shows our results todate. Reported observations included the need for good mouth opening due tothe size of the device and some difficulty inserting the device although nodevice took more than 3 insertion attempts. The failure rate was 3.75% (95%CI 0.78 – 10.57%) - the first failure was due to a poor fit, the second due tohigh airway pressures being required and the third was due to a smaller size
being required but not being available.

Contact: helen.surgenor@nhs.net

0132435

Size of AuraGain
Chart 1. Box and whisker plots to demonstrate the range of leak pressures reportedConclusions
Figure 1. Size 4 Ambu AuraGain Supraglottic Airway Device

Number %Sizeinserted male
345AllMeanBMI(SD)

Mean leakpressure(cmH20) (SD)

Cumulative %Number%stsuccess on 1 ,abandoned
traumandrd
2 & 3 insertion(%)

23.9 (7.39)

88.46/92.31/100

1 (3.85)

11.54

26

3.85

26.21
(4.97)

48

27.6
6

28.86
(5.1)

28.17 (6.21)

78.26/100/100

1 (2.08)

2.08

666.6
727.47(4.77)

30.2 (3.2)

66.67/83.33/100

1 (16.67)

0.00

22.5
0

27.93(5.11)

27.03 (6.71)

80

Table 1. Data collected based on the first 80 SAD insertions

80.77/96.15/100

3 (3.75)

5.00

This preliminary evaluation demonstrates OLPs comparable to other second
generation devices5, however we have not yet trialed enough devices todetermine a clinically useful failure rate. Similarly we did not attempt
endotracheal or nasogastric tube insertion. We have demonstrated that thedevice has a high OLP and that it merits further investigation to fully establish
its potential as a second generation device. The increased perceived difficulty
inserting the devices needs to be considered, but the relatively high successrate at inserting the devices without any provided training is reassuring.

References
1. Cook TM, Woodall NM, Frerk CM (Editors). Report and Findings. London; 2011
2. Cook TM, Kelly FE. Br J Anaesth 2015 [cited 2015 Jun 7];aev156 – Available from: http://bja.oxfordjournals.org
3. Lopez A, Sala-Blanch X, Valero R, Prats A. Open J Anesthesiol 2014;4:332–9
4. Keller C, Brimacombe JR, Keller K, Morris R. Br J Anaesth 1999; 82: 286–7
5. Mukadder S, Zekine B, Erdogan KG, et al. ScientificWorldJournal 2015: 63
Ambu (Ballerup Denmark), provided all the AuraGains used but have had no input into the evaluation, design orresults.

Summary• 80 Ambu AuraGain new second generation supraglottic airway devices (sizes 3-5) weretrialled in routine practice.
• Mean leak pressure of 27cmH20 with 100% insertion success within 3 attempts. Popularwith large number of anaesthetists.
• There was a failure rate of 3.75% [CI 0.08-10.6%], 5% incidence of trauma.
• Effective as a supraglottic airway with an OLP similar to other second generation devices.
• Further evaluation required to determine actual failure rate and function as an intubation
conduit.