King airways are great!

[TraprMike]

We recently went to King's instead of Combitubes.
I got to use one the over day on a MVA.
it went in very fast. much faster then the combi. If your service hasn't made the switch yet. push for it..

 

[STXmedic]

Welcome to the 21st century... :lol:

 

[EpiEMS]

...at least BLS folks in MN have advanced airways...
Good thing I trained in a state where BIADs for BLS are available. Those King airways are great.

 

[TraprMike]

Welcome to the 21st century... :lol:

entire state of MN says thank you..

ya young buck.. I'm assuming your pt care takes on the same tone..

 

[STXmedic]

ya young buck.. I'm assuming your pt care takes on the same tone..

Care to elaborate?

 

[the_negro_puppy]

We use LMAs :wacko:

 

[EpiEMS]

We use LMAs :wacko:

Not a fan? I've met a couple anesthesiologists and CRNAs who love them. Then again, their work environment is different from ours

 

[socalmedic]

ya young buck.. I'm assuming your pt care takes on the same tone..

says the EMT with 1/10th the post count to the paramedic...

yea, welcome to the 21st century where we are already phasing out the king because of its negative affects on cerebral blood flow.

 

[RocketMedic]

In all fairness, much of the purported negative affect of a King on cerebral perfusion is a result of hyperinflation.

 

[ExpatMedic0]

I have only used one a couple of times, however I had good compliance, and o2 saturation all the way to the hospital. Great backup airway IMO but I would need to use it more to really make a detailed observation of my own.

 

[Christopher]

entire state of MN says thank you..

ya young buck.. I'm assuming your pt care takes on the same tone..

Like PoeticInjustice our area has had KingLT's for many years now. The Combitube seemed to fall out of favor shortly after it was introduced, however, it wasn't as negligent as an EOA so it stuck around.

KingLT's have been standing order around here since 2009 at the BLS level and were in use before that on a trial basis.

 

[Carlos Danger]

negative affects on cerebral blood flow[/B].

Based on what research?

 

[STXmedic]

Based on what research?

I believe this is the article he's referring to.

I'm on my phone right now, so don't have access to further material. But feel free to look around some more if you like

 

[Christopher]

I believe this is the article he's referring to.

Probably coupled with aggregate data from the ROC trials which showed ETI had a higher survival to discharge than SGA...ignoring that BVM alone had the highest.

 

[ladysmith]

I recently received my training for both Combitube and King because our county is still phasing out the Combis, either run out or expire. Will do some additional hands on soon, but glad I have the skill introduction added to my tool belt.

 

[Carlos Danger]

I believe this is the article he's referring to.

I'm on my phone right now, so don't have access to further material. But feel free to look around some more if you like

I too figured that was the study he was referring to. I was wondering if socalmedic knew of any real evidence of SGA-induced impairment in cerebral blood flow. I did a very quick search and didn't find any.

My point was that I wouldn't exactly "welcome someone to the 21st century" by touting the abandonment of an excellent airway based on the results of a very small, non-human study.

On the other hand, there's this study, where 240,000 cardiac arrest patients over 5 years had SGA's placed and had equal neurological outcomes to those managed with an ETT.

 

[socalmedic]

that is one, another is the parallel to this being that the LMA and King when inflated cause similar pressures in the pharynx:

Colbert SA, OHanlon DM, Flanagan F, et a!: The laryngeal mask airway reduces blood flow in the common carotid artery bulb. Canadian J Anaesth. 1998 45(1): 23-7.

another study which has yet to be released is that when we used the King as first line our ROSC remained the same however our discharge with CPC 1-2 decreased 50%. the total of the data has yet to be completed as we are still waiting for 1 year results.

 

[systemet]

On the other hand, there's this study, where 240,000 cardiac arrest patients over 5 years had SGA's placed and had equal neurological outcomes to those managed with an ETT.

It should probably be emphasised that these were equally bad neurological outcomes compared to BVM. Both ETI and SGA were associated with mortality in this study.

 

[systemet]

that is one, another is the parallel to this being that the LMA and King when inflated cause similar pressures in the pharynx:

Colbert SA, OHanlon DM, Flanagan F, et a!: The laryngeal mask airway reduces blood flow in the common carotid artery bulb. Canadian J Anaesth. 1998 45(1): 23-7.

This citation doesn't support your first statement, as the article only covers LMAs. Also, while the difference is significant, the magnitude of the difference is small, you're looking at at 65.6 +/- 5.6 to 73.9 +/- 5.6 cm3.sec-1 (mean +-SEM).

When you consider this is n = 17, the scatter on this data doesn't look so wonderful. You're looking at standard deviations of 22 cm3.sec-1. This data, as I read it, is only significant because they're using non-parametric tests, including Wilcox.

Plus, they emphasise in the discussion that LMA inflation might not actually affect internal jugular caliber / flow, which is probably as important as carotid flow.

This is all surrogate outcome stuff too. No one's looking at ICP, or CBF, or cardiac arrest survival / neuro outcome here.

 

[EpiEMS]

When you consider this is n = 17, the scatter on this data doesn't look so wonderful. You're looking at standard deviations of 22 cm3.sec-1. This data, as I read it, is only significant because they're using non-parametric tests, including Wilcox.

+1

This study is only useful as a basis for which to conduct additional research -- it's a place to start, the n is way too small...