Use of the King LTS-D as a primary airway over rapid-sequence intubation medications: a prospective, consecutive case series [abstract] Abstract uri icon

abstract

  • Objective. The purpose of this study was to examine the insertion success rate and time to insertion of the King LTS-D airway for patients requiring rapid-sequence intubation (RSI) by rotor-wing emergency services personnel. Methods. Following institutional review board approval, 53 providers (registered nurses and emergency medical technician–paramedics) fromthe rotor-wing division of a single, critical care transportation organization consented to participate in the study. Following training, all patients requiring advanced airway management with RSI were screened and excluded if they met the following criteria: 1) patients with known esophageal disease, 2) patients who have ingested caustic substances, 3) patients with suspected airway burns due to thermal inhalation injury, and 4) patients known or presumed to be <4 feet or >6.5 feet in height. Following each placement attempt, providers completed data collection via telephone. The primary endpoints were overall placement success rate and time to placement of the device. Pre- and post-placement oxygen saturation (SaO2) values were compared using a paired t-test. End-tidal carbon dioxide (ETCO2) at 2 minutes after placement and complications, including vomit in the airway, are reported descriptively. Results. Between October 2008 and November 2009, 42 patients received RSI with the King LTS-D airway by 24 of the 53 participating providers. Patient demographics included: 29 of 42 (69%) trauma, 13 of 42 (31%) female, and mean (¡¾ standard deviation) age 46.3 ¡¾ 20.2 years. The first attempt success rate was 76% (32/42), with an overall success rate of 83% (35/42). The mean time to insertionwas 30.33 ¡¾ 22.12 seconds. The mean pre- and post-insertion SaO2 values were not significantly different (89.25% ¡¾ 12.4% vs. 92.67% ¡¾ 12.5%; p = 0.08). The mean ETCO2 value at 2 minutes after placement was 35.29 ¡¾ 4.04 mmHg. In 13 of 34 (38%) of the successful insertions, paramedics reported a complication. Complications were reported in 86% (6/7) of the unsuccessful insertions. The most frequently reported complications were facial trauma (16.7%) and vomiting following insertion (19.0%). Conclusions. In this small case series, the success rates and time to insertion of the King LTS-D were comparable to previously reported experience with the device. Further prospective, randomized research comparing the use of the airway against endotracheal intubation in RSI helicopter emergency medical services patients is warranted.

publication date

  • 2011