King Airways

[FFEMT150 214]

Hello all. I recently had the chance to see the "King Airway" used for the first time. Honestly I was not impressed. Seemed to me that the king airway was less effective than the OPA I had placed upon arrival. I found it more difficult to ventilate the patient and saw a great deal of gastric distention. My question for discussion is "Was the King Airway properly placed or are these time saving intubation devices just junk?" I have a feeling some of you will ask so heres some quick stats...pt was 50-60 yrs old, approx 6' tall and weighed around 380 lbs. I know this wouldnt be an easy tube normally but arent these things supposed to make intubation easier? If any one has used these and has grown fond of them please let me know. Thanks Guys and Girls and remember to make it home at the end of the day!

[NWFDMedic 58]

I've never personally used one except in class, but I've seen several of my coworkers use them. They seem to work great.

[67R93 5]

It almost seems like a personal preference thing, Some medics love them , and others want to throw them out the window.

[ny10570 745]

If you were getting abdominal distention and difficulty inflating, then the airway probably wasn't placed properly. If its placed too deep, the upper balloon will prevent the epiglottis from fully opening. The increased pressure will then force air past the lower balloon into the stomach. The proper technique is after insertion to back it out till ventilation is easy and then secure the tube in place.

[Engfire 0]

We carry them on our medics, but they are to be used as a rescue airway after failed ET tude attempts. That being said I prefer the King over the combi-tube, we do carry both as well as LMAs but our medical director only wants us using LMAs used on Pedis. To answer your question it probably wasn't placed right or wasn't the correct size.

[Medic442 15]

We had them at a company that I worked for. It wasn't bad and also had the slot for the buggie ( so you can switch back to a ET Tube ).

But would rather stay with a ET Tube.

Sounds like the placement may have been the issue.

[Guest alsfirefighter]

I've used them in the field several times where ETI proved difficult or needed to get an airway fast on a patient who wasn't in a position to facilitate ETI and have had great success with them. They are also very favorable in the tactical environment and which is also why we switched to them in the field, because they only need the one syringe to fill with air. As pointed out the issue you were having sounds like a placement issue. NY pointed it out best...once its inserted and you fill it with air pull back slightly and often you will feel for the lack of a better term a "pop" which is the large balloon sealing the oropharynx. One thing to point out they are not there to make "intubation easier." They are an adjunct airway device and not intubation. What they do do is seal the airway better then LMA's and just plain BVM ventilation. I have yet to have any success with the utilization of a bougie in conjunction with the king to exhange for an ETT.

Edited July 20, 2010 by alsfirefighter

[gpeifer 89]

The King Airway is primarily a rescue airway device. If you are not getting good ventilation you probably had incorrect insertion or chose the improper size. Providers that have used the combitube prior to the king airway might insert it as though it was a combitube which is incorrect. If not inserted from a 90 degree start position you increase your risk of tracheal insertion which you do not want to do as the King is a single lumen airway.

Why are you inserting a bougie into the airway.. it is in the esophagus. The LTS-D does provide for easier tube exchange, but most people are not purchasing the LTS-D, instead they are purchasing the more economical King LT.

The most efficient new product on the market to assist with endotracheal intubation is the SALT airway.

Guy

[Goose 188]

As was stated prior the king airway is a rescue airway. As a rescue airway I have found the two times I have used it, it has functioned flawlessly - protected and maintained difficult airways that prohibited intubation in the field.

[Guest TCA-ALS25]

We carry the LTS-D version both at TransCare and my 911 job. County protocol is 3 unsuccessful ETT attempts, then go to the King. I've never had a problem with them. We don't change out tubes, since travel time to the ED isn't that far....

[Goose 188]

Hello all. I recently had the chance to see the "King Airway" used for the first time. Honestly I was not impressed. Seemed to me that the king airway was less effective than the OPA I had placed upon arrival. I found it more difficult to ventilate the patient and saw a great deal of gastric distention. My question for discussion is "Was the King Airway properly placed or are these time saving intubation devices just junk?" I have a feeling some of you will ask so heres some quick stats...pt was 50-60 yrs old, approx 6' tall and weighed around 380 lbs. I know this wouldnt be an easy tube normally but arent these things supposed to make intubation easier? If any one has used these and has grown fond of them please let me know. Thanks Guys and Girls and remember to make it home at the end of the day!

Didn't get a chance to actually respond to the original post. You can't misplace a king airway. It's a blind insertion (and devices like this are a BLS option in other states)...lube it up, shove it down and inflate the cuff. The definitive option is always going to be endotracheal option (it's the gold standard) but intubation isn't a particularly easy skill - especially without paralytics, bright lights, a table at hip level and 3 or 4 other sets of hands. As was mentioned, it's considered a "rescue" airway...ie: s you can't get the tube, this will secure and protect the airway effectively enough (like i said, you can't beat passing a tube into the trachea and occuluding the lower airways below the vocal cords, but this is better than nothing..). As far as it being better or worse than an OPA...i think it's a better option. If you're getting good chest rise, good SPO2 and good central/peripheral perfusion with an OPA keep it (or so says the AHA)...but the biggest thing is that the king will do a better job of keeping vomit, blood, etc out of the trachea than will an OPA. As far as gastric distention...it could have been a result of the bagging the patient with a BLS airway and no cric pressure or maybe the patient was just that heavy or maybe they had some sort of hepatic congestion going on...who knows... Hopefully that answers some of you;re questions!

[ny10570 745]

You can absolutely misplace a KIng airway, or any other device for that matter.

Edited July 23, 2010 by ny10570

[INIT915 1,119]

Didn't get a chance to actually respond to the original post. You can't misplace a king airway. It's a blind insertion (and devices like this are a BLS option in other states)...lube it up, shove it down and inflate the cuff. The definitive option is always going to be endotracheal option (it's the gold standard) but intubation isn't a particularly easy skill - especially without paralytics, bright lights, a table at hip level and 3 or 4 other sets of hands. As was mentioned, it's considered a "rescue" airway...ie: s you can't get the tube, this will secure and protect the airway effectively enough (like i said, you can't beat passing a tube into the trachea and occuluding the lower airways below the vocal cords, but this is better than nothing..). As far as it being better or worse than an OPA...i think it's a better option. If you're getting good chest rise, good SPO2 and good central/peripheral perfusion with an OPA keep it (or so says the AHA)...but the biggest thing is that the king will do a better job of keeping vomit, blood, etc out of the trachea than will an OPA. As far as gastric distention...it could have been a result of the bagging the patient with a BLS airway and no cric pressure or maybe the patient was just that heavy or maybe they had some sort of hepatic congestion going on...who knows... Hopefully that answers some of you;re questions!

You can misplace a King, and you really shouldn't just "shove" anything in. There are some (perhaps even an increasing number who question the old adage of ETI being the "gold standard.") The King is a 'better' alternative to an OPA, but not completely without pitfalls. The King also has some contraindications.

[M' Ave 1,466]

Huh, I thought this was a thread about a new Airline.......oops.

[JohnnyOV 2]

You can misplace a King, and you really shouldn't just "shove" anything in. There are some (perhaps even an increasing number who question the old adage of ETI being the "gold standard.") The King is a 'better' alternative to an OPA, but not completely without pitfalls. The King also has some contraindications.

This is why I like the combi-tube a lot more. It's a simple BLS skill in other states,and besides that, no matter where the tube falls, you're going to establish an airway. If its not creating chest rise in tube 1, its going to be in tube 2; pretty much flawless as another rescue airway. Everything has its contradictions, but I personally think the combi is a better "rescue airway" option.

[ny10570 745]

Combi tube has the same contraindications and same placement issues as the king and any other rescue airway. Combi tube takes longer, only comes in latex and has 2 balloons that can fail. No airway is perfect and endotracheal intubation is still the best.

[Guest alsfirefighter]

Out of all the airways mentioned...the one I disliked the most was the combitube. Had good success with them, but it looked like a torture device being shoved in a patient's mouth, and who wants to deal with 2 syringes. I want efficiency on top of effectiveness. Also the King just like the combitube is more then likely going to end up in the esophagus. I've never hit the trachea the few times I used the combitube.

I don't know about everyone else...but the higher off the floor my patient gets the more of a pain in the butt I find it to intubate. Give me a floor..then if all else fails the stretcher...and then I have my ED stretcher technique. I also don't need all that much light..the one on the end of blade does it for me.

[toastedsound 7]

the biggest thing is that the king will do a better job of keeping vomit, blood, etc out of the trachea than will an OPA

I don't mean to be "that guy" but if the King Airway protected the lungs from vomit, blood, etc., we would never need to intubate. Fact of the matter is, it really doesn't protect the airway from those things, just merely allows for an increased tidal volume and more direct source of ventilation. The risk of aspirating foreign objects, unfortunately, is always present without a properly placed ET tube. The benefit to the King Airway over the Combitube is basically this: one less tube on the device means one step closer to being idiot proof. (NOT in a derogatory sense) The one downside, which I think answers the original question, is the different sizes. My agency carries 3 sizes, based on patient height. The provider who may have misplaced the device may have been using the wrong size.

[ny10570 745]

aside from a patient actively vomiting, the king or combi tube will stop stomach contents from reaching the airway. The real limitations with these devices is with airway trauma, burns, anaphylaxis, etc. In the hospital you have a whole different set of issues making the ETT the preferred device.

[Goose 188]

I can't see how the king doesn't do a better job at protecting the airway than an OPA...if you're talking upper airway trauma, the proximal cuff completely isolates the oro/naso pharynx from the glottic opening. Additionally, the distal cuff - while it sits in the esophagus is not guaranteed to prevent aspiration, so i correct myself there - but i feel that it does a superior job at preventing gastric insufflation which leads to less gastric distention and less chance of subsequent vomiting and aspiration.

From where i sit it seems preferable to the combi-tube and far superior to an OPA.

Good discussion.