KING TUBE COURSE - cont'd info

King Tube Features:

King Tube

  • Lubricate Tube
  • Distal cuff seals esophagus while proximal cuff seals oropharynx
  • Stable airway for 8 hours
  • Can exchange over Eshmann stylet for ETT

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King Tube Technique:

King Tube Placement

  • Lubricate King Tube cuffs
  • Place King Tube along right mouth past tongue
  • Rotate blue line anterior
  • Advance tube until red connector at teeth

King Tube Placement

  • Connect BVM bag
  • Pull tube back slowly until BVM ventilation optimized

Predictors of Difficult King Tube Insertion:

Difficult Intermediate Airway


R – Restricted mouth opening
O – Obstruction (upper airway)
D – Disrupted or distorted or opharynx
S – Stiff lungs or cervical spine

King Tube Airways are Excellent Rescue Airways for Both EMS and Medical Personnel

Joseph Esherick, M.D., FAAFP, FHM

January 11, 2018

King Tube Airways are Excellent Rescue Airways for Both EMS and Medical Personnel

If you are faced with a patient who needs a secure airway and respiratory stabilization, I still believe that endotracheal intubation is the airway of choice.  Nevertheless, there are situations when endotracheal intubation is not achievable or the airway skills of the operator would favor the placement of an intermediate airway.  In these situations, one great option is the placement of a King tube.

The King airway tubes are designed so that they can be placed easily and reliably into the esophagus by both pre-hospital (EMS) and hospital personnel.  The King tubes have an angulation that reliably directs the tube into the esophagus.  The single port can then inflate the distal esophageal and proximal supraglottic cuffs in a single step.  The tube is then connected to a bag valve mask and withdrawn with the cuffs inflated until optimal ventilation is observed and then secured at this position.

The advantages of the King tubes are that they are a stable airway for up to 8 hours and can be used for transporting patients safely to another facility.  In addition, if desired a King airway tube can be exchanged to an endotracheal tube using either an intubating stylet or a tube exchanger.  Both King tubes and laryngeal mask airways (LMA) can be used as rescue airways when endotracheal intubation is unsuccessful, but King tubes have the advantage over an LMA in that they can be used for interfacility transports and are better protection against aspiration.

The most important message is to reach for a rescue airway when you have attempted endotracheal intubation unsuccessfully 2-3 times.  This can allow for temporary stabilization of your patient while you call for additional support.