River Hospital was recently awarded a grant from the New York State Department of Health to sponsor area providers in current trauma specialties and organized a course on Fort Drum for local ambulance personnel in Army Casualty Training. A portion of the grant was to provide ambulance services with some equipment that was featured in the training; River Hospital named TIERS the recipient of King Airways to be utilized by our ALS crews.  This equates to $1600.00 worth of equipment for TIERS.

The King Airway is an alternative advanced airway device for prehospital use in securing difficult airways when endotracheal intubation is a challenge. North County EMS has advocated a secondary airway to be placed on ambulances since 2007, but the cost of implimentation has been issue for TIERS.

The King Airway utilizes two balloons to isolate the hypopharynx and laryngeal inlet. The ventilation then passes through the outlets and into the trachea. The King Airway is not a definitive airway as the tube does not pass below the vocal cords.

An endotracheal tube (ET tube) goes directly into the tracheal (windpipe) and has an air cuff on the end; this allows for air to enter the lungs and the patient cannot aspirate material into the lungs. The King airway instead inserts into the esophagus (the "food tube"), and uses a single air line to inflate both the smaller distal (esophageal--seals the esophagus to prevent air from entering the stomach and prevent stomach contents from coming up) and larger proximal (oropharyngeal--seals the throat so that respirations go to the trachea and lungs), balloons. The King airway is easier to place than an ET tube and  is designed to optimize the use of an airway exchange catheter to be directed into the trachea should the treating provider wish to change from the King to an ET tube.

TIERS will be using the King LT-D models in size 3, 4, and 5. The LT-D model does not have a gastric decompression lumen as this is not an approved prehospital skill. The picture below  summarizes the key features of the King LT-D.

In the field setting, the King Airway may be used to ventilate a patient similar to an endotracheal tube. You can ventilate using a bag-valve or ventilator utilizing a standard connector and utilize adjuncts such as end-tidal carbon dioxide monitoring or ResQ Pod. As with an endotracheal tube, adequacy of ventilation should be based on multiple criteria such as adequate chest rise, auscultation of breath sounds, wave form capnography, and/or adequate oxygenation. The esophageal balloon will prevent gastric decompression, so conversion to an endotracheal tube would be needed to achieve this task. The King Airway may be left in place for several hours, until more optimal airway management can be achieved.

Starting as soon as possible in 2012 after adequate training is completed, the King Airway will be an option for patients over four feet tall needing advanced airway management. The King Airway comes in different sizes and TIERS will be stocking size 3, 4, and 5.

The King Airway is designed to allow an airway exchange catheter to pass through the main port and into the trachea as an option to facilitate endotracheal intubation. The two balloons can be deflated using a large syringe to withdraw air from the single circuit until the pilot balloon is deflated. The airway can then be removed by rotating the airway device out. Make sure to have suction readily available and be prepared to handle potential aspiration.