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King Airways and Cardiac Arrest.


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Hello everyone. My county has adopted the King airway device in lieu of the COMBI-Tube. Who has used them and does anyone have likes and dislikes about this particular tube? On researching the tube I found this article that shows an interesting point of view on ETT vs. King tube in cardiac arrest patients. Anyone care to share personal experiances for or against this tube?

Fireman1037

http://paramedicine101.blogspot.com/2009/05/debateking-lt-for-cardiac-arrest.html

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A blog post of somebodies opinion is not really the best method for deciding for or against the efficacy of any given intervention. I do like the fact that you are looking for additional information. The truth being there is limited pre-hospital data regarding the King. However, the data regarding the use of other supraglottic airways such as the Combitube is fairly positive IMHO. An argument pitting the King against the Combitube is inane at this point with the limited data; however, from what I can see thus far the efficacy of the two devices is pretty similar.

Regarding an arrest situation; good bag mask technique ~ ETT ~ Combitube ~ LMA. The emphasis on advanced airway modalities has been removed in recent years in favour of quality, uninterrupted CPR.

Take care,

chbare.

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A blog post of somebodies opinion is not really the best method for deciding for or against the efficacy of any given intervention. I do like the fact that you are looking for additional information. The truth being there is limited pre-hospital data regarding the King. However, the data regarding the use of other supraglottic airways such as the Combitube is fairly positive IMHO. An argument pitting the King against the Combitube is inane at this point with the limited data; however, from what I can see thus far the efficacy of the two devices is pretty similar.

Regarding an arrest situation; good bag mask technique ~ ETT ~ Combitube ~ LMA. The emphasis on advanced airway modalities has been removed in recent years in favour of quality, uninterrupted CPR.

Take care,

chbare.

A blog is not about clinical studies, it's about opinions from those with practical knowledge of a device, medication, or procedure. Depending on where you look for info, there may be quite different opinions on a device. I recall getting nothing but positive cheerleading from the department when presented with new devices or protocols, and if you took them at face value, there would be no question the new idea was the best thing since sliced bread. After doing some digging on my own- from things like scholarly literature AND blogs, I found that reality was much different than what we were told. Didn't matter, since I am not in a position to make such decisions, but it did open my eyes to a few things.

Sadly, politics, money, and BS are all part of the process of getting a new idea implemented. Efficacy is not always the number one concern.

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A blog post of somebodies opinion is not really the best method for deciding for or against the efficacy of any given intervention. I do like the fact that you are looking for additional information. The truth being there is limited pre-hospital data regarding the King. However, the data regarding the use of other supraglottic airways such as the Combitube is fairly positive IMHO. An argument pitting the King against the Combitube is inane at this point with the limited data; however, from what I can see thus far the efficacy of the two devices is pretty similar.

Regarding an arrest situation; good bag mask technique ~ ETT ~ Combitube ~ LMA. The emphasis on advanced airway modalities has been removed in recent years in favour of quality, uninterrupted CPR.

Take care,

chbare.

Agreed, I wouldn't have referenced this article unless it had the case studies as well. The thing that concerns me with this tube is that, With the Combi there was a 1% chance of tracheal intubation and there was a second lumen in that instance. With a single lumen tube like this isn't there a albeit slight risk of accidentally doing this and having damage to the larynx and preventing ventilation?

Fireman1037

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I'm actually glad he used that blog post as a reference. Probably because I am favoring my own work a bit. If you read the post, I provided multiple research references. The post was more towards King LT vs. intubation for cardiac arrest. With the emphasis on continuous chest compressions, I have found that the King LT is superior [to intubation]. On the flip-side, outside of cardiac arrest, endotracheal intubation is by far a better means of controlling the airway. I wrote that particular post about a year ago, and I am sure there has been much more research provided since. A query on Pubmed may be in order. Also, I do disclaim that it is just a blog, and as I do try to only advocate evidence-based medicine, my opinion is riddled throughout.

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Hello everyone. My county has adopted the King airway device in lieu of the COMBI-Tube. Who has used them and does anyone have likes and dislikes about this particular tube? On researching the tube I found this article that shows an interesting point of view on ETT vs. King tube in cardiac arrest patients. Anyone care to share personal experiances for or against this tube?

Fireman1037

http://paramedicine1...iac-arrest.html

We started using them in our county about 2 years ago. Haven't seen any difference in airway patentcy. The King's are easier to use and alot less expensive. Many of or hospital ORs have been them exclusively for several years. They swear by them.

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  • 4 months later...

With the availability to utilize so many different airways now I believe we will see the end of intubation in the field very soon...and its death knell has already sounded in many areas. Many will scream to the bottom of the fall about it...but the reality is... the quality of airway maintenance with the King or LMA really precludes the necessity of intubation in the field. I have been "tubin'" for years but there are times, especially now that I have RSI (and in some areas RSA - the "A" being for airway, which ever is used) is becoming so prevalent that unless a medic works in a very busy system where they tube all the time, the skill is easily lost. And we all know how diligent every medic is about keeping up their skills :o

My personal policy in the field (and my company's, as I own a small side EMS company that does Special Event EMS) is if the tube isn't hit first time go to a King or LMA and be done with it. This is especially true in cardiac arrest situations. Here, we have been using CCR for many years, and the most valuable lessons are saving time and concentrating on the basics. Much valuable time is wasted in a code if medics are more concerned about "gettin' the tube" than keeping up good compressions and appropriate electric/drug therapy.

I only use the King LTS-D's as they work very well, they're easy to insert without the necessity of multiple syringes to fill lumens, take up far less space in a tube roll, and they can also be suctioned through. And, if you get the chance, get your medical director to let you do a field study, only if you have capnography, and set it up so that you can evaluate the oxygenation of both airways (King and intubation). Then compare the ABG's when they arrive at the ED. You will be quite surprised at the results and may also make you rethink the "necessity" of keeping intubation in your system. Sometimes we have to evaluate when some of our skills are more ego than practical. I'm sure that that will upset some of my fellow "old timers!" :)

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The King is a good airway. I don't see great advantages over the combi except size and weight and simplicity. The US military is using the King extensively in the field. I much prefer it to the LMA.

'zilla

(gingerly sidesteps the paramedic intubation debate)

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With the availability to utilize so many different airways now I believe we will see the end of intubation in the field very soon...and its death knell has already sounded in many areas. Many will scream to the bottom of the fall about it...but the reality is... the quality of airway maintenance with the King or LMA really precludes the necessity of intubation in the field. I have been "tubin'" for years but there are times, especially now that I have RSI (and in some areas RSA - the "A" being for airway, which ever is used) is becoming so prevalent that unless a medic works in a very busy system where they tube all the time, the skill is easily lost. And we all know how diligent every medic is about keeping up their skills :o

My personal policy in the field (and my company's, as I own a small side EMS company that does Special Event EMS) is if the tube isn't hit first time go to a King or LMA and be done with it. This is especially true in cardiac arrest situations. Here, we have been using CCR for many years, and the most valuable lessons are saving time and concentrating on the basics. Much valuable time is wasted in a code if medics are more concerned about "gettin' the tube" than keeping up good compressions and appropriate electric/drug therapy.

I only use the King LTS-D's as they work very well, they're easy to insert without the necessity of multiple syringes to fill lumens, take up far less space in a tube roll, and they can also be suctioned through. And, if you get the chance, get your medical director to let you do a field study, only if you have capnography, and set it up so that you can evaluate the oxygenation of both airways (King and intubation). Then compare the ABG's when they arrive at the ED. You will be quite surprised at the results and may also make you rethink the "necessity" of keeping intubation in your system. Sometimes we have to evaluate when some of our skills are more ego than practical. I'm sure that that will upset some of my fellow "old timers!" :)

Ever see a King or Combi used in ICU ?

Ever see a #4.0 King Tube ?

It appears that once again plastic technology wins over education, practice and proven experience ... and then the second procedure exposing the patient to increased possibility of aspiration.

This debate is noting to do with "old school" or "egos" it has do do with what is the best and safest procedures, but it does have a LOT to do with marketing and studies based on less than stellar services.

cheers

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We have been using the LMA for about six years, it works well and most of them are used in cardiac arrest; lube it up, shove it in, blow up the cuff and viola.

If an LMA is in place (regardless of setting) and working well we are actively discouraged from swapping it over to an endotracheal tube

See our basic airway management CCE videos here

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