Abdominal Compartment Syndrome in the Trauma Patient Who Received Kings Airway in the Pre-Hospital Setting

Background: The Kings Laryngeal Tube is a popular prehospital device used in the difficult airway. Since its introduction in 1999, the literature has cited a “first-pass rate” as high as 100% in some studies. Complication rates reported in the literature most cite low morbidity events such as aspiration and mucosal injury. Risk of dislodgement is seldom described in the literature and is likely underreported. Objective: Discuss the unique presentation, diagnosis, and management of a patient who suffered from abdominal compartment syndrome secondary to dislodged Kings LT and severe gastric distention. Case Report: A 60-year-old male presented with multiple traumatic injuries after being thrown several feet by a large SUV. The patient was altered in the field and experiencing significant hematemesis compromising his airway. Initial attempts to intubate the patient were unsuccessful with an ETT however a Kings LT was successfully placed. Ventilation with the supraglottic airway was continued into the trauma bay however his SpO2 never improved beyond 90%. After several minutes, the King’s LT was removed and an ETT was attempted under video assistance, however, this was also unsuccessful. A surgical airway was obtained however the patient still did not improve from a respiratory standpoint. During this series of events, his abdomen was becoming increasingly distended and his chest rise was poor bilaterally. Clinically he demonstrated signs of abdominal compartment syndrome. He underwent emergent decompressive laparotomy at the bedside. His stomach was noted to be severely distended and his small bowel was diffusely dilated as well. The maneuver instantly improved his O2 saturations and normalized his vital signs. Patient was subsequently transferred to OR for application of a temporary closure device and repair of his other injuries. Conclusion: Severe gastric distention and abdominal compartment syndrome secondary to tracheal dislodgement in a King’s Laryngeal Tube is a rare entity that should be considered as one of the potential complications of insertion.