Source:The Journal of Emergency Medicine
Author(s): Kenneth W. Dodd, Rebecca L. Kornas, Matthew E. Prekker, Lauren R. Klein, Robert F. Reardon, Brian E. Driver
BackgroundRemoval 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.ObjectiveOur objective is to provide preliminary validation of this technique.MethodsEmergency 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.ResultsThere 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.ConclusionsEmergency 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.
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