Failure to Ventilate with Supraglottic Airways after Drowning

We report the failure of an i-gel^® and an Ambu^® AuraOnce™ supraglottic airway to ventilate a drowning victim. Failure was attributed to changes in lung physiology following submersion and inhalation of water that may have required ventilation pressures up to 40 cmH₂O to treat the victim's hypoxaemia. The ease of use and rapid insertion of supraglottic airways without interrupting cardiac compression has prompted recommendations for their use during resuscitation. The relatively low leak pressures attainable from many supraglottic airways, however, may cause inadequate lung ventilation and entrainment of air into the stomach when these devices are used in drowning victims.