Use of the King LT for emergency airway management

Objective: To discuss the role of the King LT reusable supraglottic airway in emergency airway management. Design: Retrospective case series review. Setting: Tertiary academic medical facility. Patients:Westudied patients who presented to the emergency trauma center having undergone intubation at an outside facility or at the scene of the incident. The otolaryngology service was consulted for definitive management of the airway. Main Outcome Measure: Airway evaluation and management once the King LT has been placed. Results: Six patients with known prehospitalization use of the King LT presented to the emergency trauma center and subsequently required emergency tracheostomy for establishment of a secure airway. Fiberoptic and/or direct laryngoscopic evaluation performed with the tube in place failed to reveal whether safe oral endotracheal intubation could be performed because of visualization problems. Examination after tracheostomy and removal of the King LT revealed that in 2 patients, orotracheal intubation would have been difficult or impossible, whereas another 4 patients could have been intubated. One patient had prehospitalization placement of a King LT, which resulted in subcutaneousemphysemabecause of placement within the mediastinum. The patient was able to be successfully intubated and did not require tracheostomy. Conclusions: 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.