Use of the King LT for Emergency Airway Management

Abstract

The King LT offers benefits in emergency situations, but evaluation of the airway is challenging and often necessitates tracheostomy for establishment of a safe and secure airway. Even if tracheostomy is not required, serious complications may occur.

Overinflation of a King LT Extraglottic Airway Device Mimicking Ludwig’s Angina

“…30 In those situations, like in our case, the safest course is to establish a surgical airway. The surgical airway is 1 of only 5 broad techniques that health care providers can use to oxygenate and ventilate an apneic patient (bag and mask, EGD, ETT, and extracorporeal membrane oxygenation are the other options) and should not be considered a failure of airway management.…”

Definitive airway management of patients presenting with a pre-hospital inserted King LT(S)-D™ laryngeal tube airway: a historical cohort study

“…19 Data from our much larger series argues against this strategy for non-trauma patients. A further argument against routine tracheostomy is that the majority of patients presenting with a King LT either died (30 [62%] patients) within two days of hospital admission due to complications associated with their illness or tracheal extubation was performed within seven days, i.e., before a tracheostomy is often considered for weaning from the ventilator.…”

“…These processes can result in pharyngeal, glottic, and lingual edema. 7,17,18 This upper airway edema has been reported with use of the Combitube, 17 King LT, 19 and the original laryngeal mask supraglottic airway 20,21 and complicates the subsequent exchange of this device for a more definitive airway. In our cohort, 19% of patients displayed clinically significant upper airway edema requiring the use of advanced airway management techniques beyond simple direct laryngoscopy for subsequent management.…”

Airway algorithm for the management of patients with a king LT

“…Alternatively, visualization with these adjunct tools may allow determination that the tube cannot be safely exchanged, for instance, if there is significant airway edema, and tracheostomy may be necessary to secure the airway as was determined in a third of our patients, both in our current study and our previous study. 3 A secondary plan for dealing with the airway is imperative should tube exchange prove impossible, and tracheostomy may be necessary.…”

“…In our previously published article we discussed some of the advantages of the King LT, which includes fast insertion time (10–20 seconds) with a high success rate of placement (86%–100%), as demonstrated by previous studies . However, the design of the tube results in a high risk of anatomic distortion and pharyngeal edema, in particular anterior tongue swelling, often making orotracheal intubation difficult …”