A Comparison of the King-LT to Endotracheal Intubation andCombitube in a Simulated Difficult Airway

Abstract

Background. Prehospital endotracheal intubation (ETI) is a complex skill to maintain proficiency. Several airway adjuncts are available for prehospital providers. A recent alternative is the King Laryngeal Tube (LT) approved for use by the FDA in 2003. The aim of this study was to determine if the King-LT offers improved placement success andtimes over the Combitube (ETC) andendotracheal tube (ETT) in a simulated difficult airway. Methods. Sixty-nine prehospital providers (EMT-Bs andEMT-Ps) were timed in a series of trauma scenarios involving the placement of an ETT, ETC, andLT in a difficult airway simulator. Primary outcome measures were placement time (seconds) andsuccess for each device. Successful placement in the manikin was defined by adequate placement depth, inflation of device cuffs, the presence of breath sounds, andthe absence of epigastric sounds. Results. EMT-P mean placement times were 91.3 seconds (76.6–106.0) for ETT, 53.7 seconds (48.3–59.1) for ETC, and27.0 seconds (24.3–29.7) for LT. EMT-B mean placement times were 46.4 seconds (37.5–55.3) for ETC and22.5 seconds (19.0–26.0) for LT. Subgroup analysis was completed andcompared in groups that either checked or did not check device balloons prior to insertion. EMT-Ps successfully placed an ETT in 68.9% (31/45) of attempts. EMT-P success for ETC andLT scenarios were 82.2% (37/45) and100% (45/45). EMT-B success in the ETC was 87.5% (21/24) and100% (24/24) with the LT. Differences in successful placement between all devices were significant for paramedics only. A survey was provided following the scenarios to assess comfort andease of each device; 17/45 EMT-P participants noted the ETT to be “difficult” to place versus 38/45 reporting the King-LT to be “easy” or “very easy.” Conclusions. The King-LT is a relatively new airway device with time andsuccessful placement advantages over ETT andETC.

Keywords:

• airway
• EMS
• intubation