Ep. 20 - Out of Hospital Airway Adjuncts: King Tube vs LMA

Mar 14, 2025

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INSIGHT

Airway Management Spectrum Explained

Airway management spans a spectrum from mouth-to-mouth resuscitation to definitive airways like intubation and cricothyroidotomy.
Using simple adjuncts like oral and nasal pharyngeal airways helps maintain airway patency before moving to advanced devices.

INSIGHT

King Tube vs LMA Mechanisms

King Tube is inserted blindly into the esophagus with two balloons to seal around the laryngeal opening.
Laryngeal Mask Airways (LMAs) like IGEL seal directly over the larynx, providing a potentially better airway seal.

INSIGHT

IGEL Shows Superior Survival Outcomes

Retrospective CARES registry data showed IGEL use increased odds of neurological survival by 45% compared to King Tube.
IGEL was also linked to improved survival to hospital admission and discharge.

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King Tube vs IGEL for Airway Management

In this episode of Wilderness Medicine Updates, Dr. Patrick Fink addresses a listener's question on whether to use a King Tube or an IGEL as an out-of-hospital airway adjunct. The episode begins with an overview of airway management techniques from mouth-to-mouth resuscitation to supraglottic airway devices. Dr. Fink explains the benefits and drawbacks of various airway adjuncts, including oral and nasal pharyngeal airways. The discussion then shifts to a detailed comparative analysis of King Tubes and IGELs based on retrospective and prospective studies. Dr. Fink evaluates the evidence indicating that IGEL may be more effective and easier to use than King Tubes, particularly in pre-hospital cardiac arrest situations. The episode concludes with recommendations for pre-hospital providers and an encouragement for listeners to share their questions and feedback.

Links:

iGel LMA

King Tube

Smida T, Menegazzi J, Scheidler J, et al. A retrospective comparison of the King Laryngeal Tube and iGel supraglottic airway devices: A study for the CARES surveillance group. Resuscitation. 2023;188:109812. doi:10.1016/j.resuscitation.2023.109812

Smida, Tanner & Menegazzi, James & Crowe, Remle & Scheidler, James & Salcido, David & Bardes, James. (2023). A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Prehospital emergency care. 28. 1-13. 10.1080/10903127.2023.2169422.

Lønvik, M.P., Elden, O.E., Lunde, M.J. et al. A prospective observational study comparing two supraglottic airway devices in out-of-hospital cardiac arrest. BMC Emerg Med 21, 51 (2021). https://doi.org/10.1186/s12873-021-00444-0

Chapters

00:00 Introduction and Listener Question

00:55 Understanding Airway Adjuncts

02:12 Basic Airway Management Techniques

06:34 Advanced Airway Devices: King Tube and LMA

11:35 Comparative Studies on Airway Devices

17:35 Prospective Data and Final Thoughts

25:24 Conclusion and Listener Engagement

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