title: Endotracheal Intubation with the King Laryngeal Tube™ In Situ Using Video Laryngoscopy and a Bougie: A Retrospective Case Series and Cadaveric Crossover Study.
abstract: BACKGROUND
  Removal of a functioning King laryngeal tube (LT) prior to establishing a definitive airway increases the risk of a "can't intubate, can't oxygenate" scenario. We previously described a technique utilizing video laryngoscopy (VL) and a bougie to intubate around a well-seated King LT with the balloons deflated; if necessary, the balloons can be rapidly re-inflated and ventilation resumed.
  
  
  OBJECTIVE
  Our objective is to provide preliminary validation of this technique.
  
  
  METHODS
  Emergency physicians performed all orotracheal intubations in this two-part study. Part 1 consisted of a historical analysis of VL recordings from emergency department (ED) patients intubated with the King LT in place over a two-year period at our institution. In Part 2, we analyzed VL recordings from paired attempts at intubating a cadaver, first with a King LT in place and then with the device removed, with each physician serving as his or her own control. The primary outcome for all analyses was first-pass success.
  
  
  RESULTS
  There were 11 VL recordings of ED patients intubated with the King LT in place (Part 1) and 11 pairs of cadaveric VL recordings (Part 2). The first-pass success rate was 100% in both parts. In Part 1, the median time to intubation was 43 s (interquartile range [IQR] 36-60 s). In Part 2, the median time to intubation was 23 s (IQR 18-35 s) with the King LT in place and 17 s (IQR 14-18 s) with the King LT removed.
  
  
  CONCLUSIONS
  Emergency physicians successfully intubated on the first attempt with the King LT in situ. The technique described in this proof-of-concept study seems promising and merits further validation.
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Dodd
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Kornas
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Prekker
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Klein
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Reardon
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Driver
mesh_terms: D058109:Airway Management / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D002102:Cadaver; D018592:Cross-Over Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D004867:Equipment Design / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D007828:Laryngoscopy / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D014741:Video Recording / Q000295:instrumentation / Q000379:methods
keywords: King laryngeal tube; airway management; endotracheal intubation; extraglottic airway; video laryngoscopy