title: Tracheal Malplacement of the King LT Airway May Be an Important Cause of Prehospital Device Failure.
abstract: BACKGROUND
  The King LT airway (King Systems, Noblesville, IN) is a popular extraglottic device that is widely used in the prehospital setting. We report a case of tracheal malplacement of the King airway with a severe kink in the distal tube.
  
  
  METHODS
  A 51-year-old unhelmeted motorcyclist collided with a freeway median and was obtunded when paramedics arrived. After bag mask ventilation, a King airway was placed uneventfully and the patient was transported to the emergency department. Because of the concern for an unstable cervical spine injury, a lateral cervical spine radiograph was obtained on arrival. No cervical injury was seen, but the King airway was noted to be malplaced; the King airway passed through the laryngeal inlet and became lodged on the anterior trachea, creating an acute kink between the two balloons. After reviewing the radiograph, ventilations were reassessed and remained adequate. Both balloons were deflated, and the King airway was removed; the patient was orotracheally intubated without complication. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The King airway is a valuable prehospital airway that can be placed quickly and blindly with high success rates by inexperienced providers; the King airway, however, is not without complication. Ventilation was not impaired in this patient, but tracheal malplacement may be an important cause of prehospital device failure. If a first placement attempt of a King airway device fails, it is reasonable to reattempt King airway placement with a new, unkinked device before abandoning King airway placement.
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Driver
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: David
authors.initials: D
authors.lastname: Plummer
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: William
authors.initials: W
authors.lastname: Heegaard
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Reardon
mesh_terms: D004632:Emergency Medical Services; D004868:Equipment Failure; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation*; D008875:Middle Aged; D014132:Trachea
keywords: King airway; airway device complication; airway management; extraglottic airway; prehospital; supraglottic airway