Performance of the i-Gel Versus King LT-D by Combat Medics Under Simulated Tactical Conditions: A Prospective Randomized Crossover Study

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.