The King Vision (KV) has emerged as the prehospital video laryngoscope of choice within the local EMS regions. As such, many providers may be seeking information and training on this device. King Systems provides a series of videos offering an overview and operational guidelines on its use.
Some highlights from these videos:
- The blade must be attached prior to powering the unit on.
- If using the channeled blade, the ET tube can be preloaded. Remove the stylet prior to insertion in the channel.
- A stylet should remain in place in the ETT when using the non-channeled blade. A 60-70 degree bend 2-3” from the distal end of the tube is recommended. Additionally, lubrication of the stylet is advised. This blade may be employed as either a Mac or Miller blade: inserted into the vallecula or directly beneath the epiglottis.
- It is recommended that the device be held between the thumb and first two fingers, rather than within the closed fist, for improved tactile sensation and control.
- If the blade is advanced too far into the oropharynx, tube placement can be obstructed by the camera lens. If this occurs, withdraw the blade slightly to improve the ETT’s angle of insertion.
- If necessary due to positioning constraints, the blade can be rotated into place similar to the technique employed for an OPA, or the blade can be positioned in the airway before the display unit is attached.
There is some recent literature which looks at the device in clinical use.
A Polish study put the KV in the hands of final year paramedic students and compared it against other airway devices in the setting of simulated vehicle entrapment (the manikin was positioned sitting up under a desk). The results of this study found the intubating LMA superior to the KV and other devices. More interesting, perhaps, is how the KV compared against a standard laryngoscope/Mac:
|Time to intubate entrapped patient (sec)||Success rate (30 attempts)||Time to intubate supine patient (sec)|
|Laryngoscope & Mac blade||24.7||60%||16.7|
A study of 50 patients published in June saw all 50 successfully intubated with the device, including 11 of who were considered difficult airways.
A third study published in March compared the KV against two other devices in the hands of inexperienced intubators. They found all three devices performed well with the Airway Scope being faster than the KV in the setting of the difficult airway.
Dr. Minh LeCong gives the device a very favorable review over at EMCrit; this is highly recommended reading.
Finally, a couple of alternative techniques from Paramedic Chase Frost and Dr. Jim DuCanto:
If you have any experience with the King Vision in the prehospital/transport environment, please share your experience via the comments.