Question: In the ALS patient care standards it states that a Supraglottic Airway (King) is indicated when "Need for ventilatory assistance OR airway control AND Other airway management is inadequate or ineffective" In the "un-controlled" world of EMS would it not be more effective to use a King over an oral airway after the first round of CPR is complete? The King allows for movement from the floor to stretcher with no worry about "losing" your airway. It also doesn't fall out as an oral airway will in the difficult situations/extrications we face in the field. The fear of gastric distention is also completely alleviated, making the King more effective. It would also allow for constant compressions, which is the best treatment for cardiac arrest patients in pre-hospital settings according to the Heart & Stroke. I have had many discussions with other paramedics and they seem to think that you can't use the King at all if you have an oral airway that is giving adequate control. So my question is, if you use the King on VSA patients, is it acceptable even if the oral airway will work (just not as adequately or effectively in my opinion)?
First, great question! The short answer is yes, you are able to use the King LT in the situations you mentioned.
With the slight change in wording for the use of the King LT, you are now able to use your educated clinical judgment to make the decision as to what method of airway management is best suited to you, your patient, and the situation. For example, if your patient initially meets the criteria for a Medical TOR (you think you're going down that pathway), and the OPA is providing adequate airway patency, then you are welcome to continue using it and not insert the King LT. Keep in mind that in this particular situation, you will not need to be moving the patient to the stretcher, down a flight of stairs, or continue ventilation during a bumpy Code 4 trip back to the ED.
Now, in the alternative scenario, where your patient does not meet the criteria for the Medical TOR, and you know that you'll be transporting, it may (based on your educated clinical judgment) make more sense to insert the King LT. In this situation, you're anticipating the transfer to the stretcher, trip down a flight of stairs, and the bumpy drive to the ED.
As for timing of King LT insertion; if you've decided that insertion is preferred or required, there is no hard and fast rule about when to do so. We have shared as a teaching point to make your first attempt following the first analysis as this allows both for pre-oxygenation (prior to the first analysis), and a second attempt should you need it (following the third analysis).
Bottom line: you're welcome to use either method, however, keep in mind the current and future management of the patient as the call progresses.