How to Intubate Around a King LT

Short Attention Span Summary

Intubate around the King LT
Here is the technique used in this study.  When a King laryngeal tube (LT) is in place, a video laryngoscope (VL) is placed anterior to it while ventilation is continued.  Then the large balloon is deflated to hopefully reveal the vocal cords; a bougie is placed; then the ETT is passed.  This was a 2-part study.  In part one, 11 VL videos while leaving the King LT in situ were reviewed.  First-pass success was 100%, with a median time to ETT of 43 seconds.  In part 2, paired cadaveric intubations were performed, first around a King LT in situ paired with an ordinary intubation with no King LT in place, the physician serving as his or her own control.  First-pass success was also 100% with a median time to intubation of 23 seconds with the King in situ and 17 seconds without it in the way.

Spoon Feed
If a King LT was placed due to a difficult airway scenario, removal could place you in a "can't intubate - can't oxygenate" situation.  It appears feasible to insert the video laryngoscope while ventilating through the King, then deflate the large balloon to reveal the cords, place a bougie, and intubate past the King.


Abstract

J Emerg Med. 2016 Nov 19. pii: S0736-4679(16)30906-4. doi: 10.1016/j.jemermed.2016.10.026. [Epub ahead of print]

Endotracheal Intubation with the King Laryngeal Tube™ In Situ Using Video Laryngoscopy and a Bougie: A Retrospective Case Series and Cadaveric Crossover Study.

Dodd KW1, Kornas RL2, Prekker ME3, Klein LR2, Reardon RF4, Driver BE4.

Author information:

1Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.

2Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.

3Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.

4Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.

Abstract

BACKGROUND:

Removal of a functioning King laryngeal tube (LT) prior to establishing a definitive airway increases the risk of a "can't intubate, can't oxygenate" scenario. We previously described a technique utilizing video laryngoscopy (VL) and a bougie to intubate around a well-seated King LT with the balloons deflated; if necessary, the balloons can be rapidly re-inflated and ventilation resumed.

OBJECTIVE:

Our objective is to provide preliminary validation of this technique.

METHODS:

Emergency physicians performed all orotracheal intubations in this two-part study. Part 1 consisted of a historical analysis of VL recordings from emergency department (ED) patients intubated with the King LT in place over a two-year period at our institution. In Part 2, we analyzed VL recordings from paired attempts at intubating a cadaver, first with a King LT in place and then with the device removed, with each physician serving as his or her own control. The primary outcome for all analyses was first-pass success.

RESULTS:

There were 11 VL recordings of ED patients intubated with the King LT in place (Part 1) and 11 pairs of cadaveric VL recordings (Part 2). The first-pass success rate was 100% in both parts. In Part 1, the median time to intubation was 43 s (interquartile range [IQR] 36-60 s). In Part 2, the median time to intubation was 23 s (IQR 18-35 s) with the King LT in place and 17 s (IQR 14-18 s) with the King LT removed.

CONCLUSIONS:

Emergency physicians successfully intubated on the first attempt with the King LT in situ. The technique described in this proof-of-concept study seems promising and merits further validation.

Copyright © 2016 Elsevier Inc. All rights reserved.

PMID: 27876327 [PubMed - as supplied by publisher]