King airway use by air medical providers

Background. In cases of difficult or failed endotracheal intubation (ETI), alternate airways are designed to provide adequate oxygenation and ventilation until a definitive airway can be established. The King Laryngeal Tube Disposable (LTD) is a new superglottic alternate airway. Objective. To describe the use, rates of success, and outcomes of the King airway by highly skilled prehospital providers. Method. In this retrospective analysis, we examined prehospital King airway use by a large regional air medical service for the period from March 2006 to December 2006. Rescuers used alternate airways after three unsuccessful ETI attempts or in situations of anticipated ETI difficulty. We identified clinical characteristics, described airway difficulties, and determined the success of airway placement. Where available, we evaluated the hospital course and outcomes. Results. Of 575 ETI, alternate airways were used in 27 cases, including 26 King airway placements (4.5%, 95% CI: 3.0 - 6.6%). All were successfully placed; 24 required one attempt, and two required more than one attempt. No immediate complications were observed. No prehospital surgical airways were performed. Follow-up data were available for 15 of 26 patients. Five patients were in cardiac arrest and did not survive to hospital admission. Many of the patients required specialized efforts from anesthesia or surgery for definitive airway management with 40% (4/10) requiring emergent tracheostomy. Conclusion. In this series of critically ill patients, air medical providers successfully used the King airway as an alternate airway device. Definitive airway management was complicated and required specialized efforts from surgery and anesthesia.