King VS ET

LOL Delta ^

God that is so true.
 
If you think that the arrest was precipitated by respiratory then in may be prudent to try harder for an ETT. Or if you can sink the tube during compressions or during a rhythm check then go for it. But compressions should not be stopped solely to place an ETT if your BLS airway techniques are working.
 
STXmedic said:
I stand corrected [emoji1] Thank you! Yeah, the Combi and the King make sense to me, but the LMA does not.
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What does make any comparison here invalid is the fact that these studies were done in PIGS....who were in CARDIAC ARREST......any attempt to draw a parallel between the CBF of a dead pig receiving CPR and the CBF of a living human with a perfusing rhythm is simply beyond reason.

FWIW, some of the LMA's are really great devices that should, IMO, be much more readily embraced by the EMS community. I never really liked the combitube (though it was a good backup before LMA's became common), and I've never placed a King in anything but a manikin. But I've used lots of different kinds of LMA's, and a good LMA is really where it's at.
 
Remi said:
What does make any comparison here invalid is the fact that these studies were done in PIGS....who were in CARDIAC ARREST......any attempt to draw a parallel between the CBF of a dead pig receiving CPR and the CBF of a living human with a perfusing rhythm is simply beyond reason.

FWIW, some of the LMA's are really great devices that should, IMO, be much more readily embraced by the EMS community. I never really liked the combitube (though it was a good backup before LMA's became common), and I've never placed a King in anything but a manikin. But I've used lots of different kinds of LMA's, and a good LMA is really where it's at.
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We use iGels as our backup out here with some 37fr combis still left over. we are debating adding King LTDs as a second backup to replace the few MLAs we have left. The iGel so far works rather well, but too much secretions and it does start to have problems.
 
If a BVM+OPA is working, I'd focus on compressions and reversing the cause of the arrest over placing a SGA or ETT. If the cause was respiratory, an ETT would be nice. SGA can be placed without interupting compressions, but so can an ETT if you have the right tools/provider.

Now if you have someone with a pulse who needs airway maintenance, I'd absolutely want a SGA or ETT, especially if I have to move them any significant distance (stairs, trail, rock, snow, ice). OPA+BVM is a nice solution if you are in a comfy ambulance.
 
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From an ED perspective, I'll say our Respiratory Therapists will remove EMS-placed Kings and, assuming the Pt is still in respiratory arrest, replace it with an ET. For cardiac arrest, I will be honest and say I can't recall what they do. I believe all of the codes I've been in at this hospital the Pt arrived with an ET already in place, which we just worked, obviously. All trucks that hit our doors are either Medic-Medic or Medic-EMT (and that EMT can place a King), so we always have an advanced airway present on arrival, and I assume they choose ET. I can't seem to find their generic cardiac arrest algorithm which would state what is placed, and by who. I'll have to ask, I'm curious if they have a specific rule, or if anyone can place any airway in their scope. I'll ask RT what they'd do if a cardiac arrest Pt came in with a King.

Just a thought, but what about placing an ET while the monitor is analyzing or Doc is checking pulse or any other mandatory pauses like that?
 
Grimes said:
Just a thought, but what about placing an ET while the monitor is analyzing or Doc is checking pulse or any other mandatory pauses like that?
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If they can get the tube during a rhythm check then that is great. However most of the time we will check pulse, analyze rhythm, and shock in ~ 10sec. Not always enough time.

In our hospital it is very MD dependent. Some MDs will want to intubate almost immediately. Others will wait it out. One does not like to intubate unless we get ROSC or BLS techniques are not working.
 
Grimes said:
Just a thought, but what about placing an ET while the monitor is analyzing or Doc is checking pulse or any other mandatory pauses like that?
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Well, that was always the goal in the past (before the really BIG push towards not interrupting compressions that started a few years ago), and it just didn't work. It very often takes a lot longer than a few seconds to place an ETT, and we know now that maintaining perfusion pressure is much more important.

An ETT can sometimes be placed with compressions ongoing, but there's simply no reason for it, since it doesn't contribute to improved outcome. It's normally much easier to just slide in a SGA, and you can later exchange the SGA for an ETT if you get ROSC.
 
Many services still place ego over outcome. "What do you mean you can't intubate while compressions are ongoing? Obviously you're not high-speed, low drag."


It's just our own ego getting in the way when we refuse to recognize that the only thing making a difference is fast, effective, un interrupted compressions and electricity.

If you really have to have an airway, use an SGA or a BVM and OPA. If you really have to have an IV, drill an IO.

I often also hear the argument, "we practice these skills on patients in cardiac arrest, so we can perform them effectively on live patients." That certainly is a valid reason, but there is a difference between a truly viable sudden cardiac arrest patient and the run-of-the-mill arrest which we've all run.
 
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We had some demo VividTrac video laryngoscopes come through recently. 75 dollars each (plus software) and you plug it into your tablet. The videos provided showed them in use with compression in progress with no difficulty.

Unfortunately I doubt we will get them. Too much provider pride here, I guess. Apparently not missing tubes for a year means you'll never face a challenging intubation ever.
 
Thanks for the replies guys, answered my questions. I asked one of the RTs today about King vs ET, and she, surprisingly attimently, said that she personally loves SGAs and as long as she confirms that it is correctly placed an the airway is secure, it doesn't need to be replaced by an ET. That said, most of the times one of the first things the MD orders is to get an ET in. We ended the conversation agreeing that an airway was an airway.

:P Out of the blue she also mentioned hating LMAs.
 
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