Ambu’s pediatric laryngeal tube innovation is a game-changer for prehospital providers

The following is paid content sponsored by Ambu

By Jonathan Lee for EMS1 BrandFocus

It has been almost a decade since the American Heart Association began to recognize the value of supraglottic airways (SGA) and deemphasize the role of intubation within its guidelines. Despite these recommendations, the smaller the patient gets, the less likely prehospital providers are to use an SGA. Research indicates that one possible cause of this is the lack of availability of pediatric sized SGAs designed for EMS.

Recently, Ambu has taken a big step towards correcting this problem with the introduction of its pediatric King LTS(D). Here's how it was developed and became a tool to help the tiniest of patients.

A HISTORICAL PERSPECTIVE: KING LT

The LT (laryngeal tube), a reusable single lumen device, was originally brought to market in Europe by VBM Medical in 1999.

King Systems collaborated with VBM to offer the adult King LT to the U.S. in 2003, and immediately set out to develop the adult sizes of the disposable KING LT-D, which was launched in 2004. This initial version of the "King airway" found immediate appeal in the prehospital setting as a simpler, less traumatic version of the widely accepted Combi tube.

With the launch of the double lumen King LTS-D (the first disposable SGA with a dedicated suction or gastric access channel) in 2006, the King airway became the shared intellectual property of King (later Ambu) and VBM, said Tom McGrail, the director of clinical services for Ambu.

McGrail is a biomedical engineer with extensive disposable airway device experience (face masks, SGA's, ETT's and trachs) who has been responsible for much of the recent innovation within the product line. Throughout the process, he said he used clinical observation as well as numerous airway workshops to get feedback directly from healthcare providers.

At that point, only adult sizes of the King airway (LT-D or LTS-D) were available. Child sizes 2 and 2.5 of the single lumen LT-D, able to accommodate patients as small as 12 kg, were added in 2008. But challenges remained to address the anatomy of infants.

INNOVATING FOR PEDIATRICS

Pediatric airways are not just smaller versions of adults; therefore, they required more than just a smaller version of the King LT. In particular, the design of the distal tip of the LT, which seats in the upper esophagus, had to be modified. 

Children's airways are, relatively speaking, much smaller and compliant than adults. The company worked to innovate the King LT model to better fit its youngest patients.

The distal tip of the laryngeal tube along with its inflatable balloon provides a seal of the esophagus to prevent gastric insufflation. However, in infants, the tip and balloon, which is situated behind the airway in the hypopharynx, could cause occlusion of the more distensible cartilaginous rings of the trachea.

The answer was to employ a flattened distal tip and balloon, which is fundamental to the double lumen LTS-D design. More work was required to find the correct dimensions for both the ventilation and gastric access channels to allow for maximal flow, structural support as well as secondary ventilation openings.

A PEDIATRIC SOLUTION

Once the final hurdles of manufacturing and regulatory approval were cleared, Ambu introduced the size 1 and size 0 King LTS(D).

The new sizes had some subtle differences. At 9mm, the external diameter was approximately half that of the adult version.

The other change is the way they are sized. The adults are sized based on patient height. The new infant version is by weight: size 1 for 5 to 12 kg patients and size 0 for under 5 kg.

Like their adult counterparts, they also can accommodate suction or gastric tubes, up to 10fr in size.

Along with the size 0 and 1 King LTS-D, Ambu now also offers sizes 2 and 2.5 with a gastric access channel, whereas these child sizes were previously only available as a single lumen LT-D without the gastric lumen. This means that the King LTS-D is now available in all sizes from infant to large adult.

IMPORTANCE FOR PREHOSPITAL PROVIDERS

The new offering is important for prehospital providers for a number of reasons.

First, paramedic comfort and experience tends to decrease along with the size of the patient. The King LTS(D) is now available as a rescue device for any pediatric or neonatal patient who may be a difficult or failed intubation.

In fact, case studies have reported it use in neonates as small as 1600 grams.

Second, as the value of prehospital intubation in pediatrics comes under increasing scrutiny, the King LTS(D) will see increasing use as a primary airway by providers of all levels.

Finally, recognizing the effects of poorly performed chest compressions, the King LTS(D) provides for rapid insertion which minimizes the risk of interruption to CPR. 

Ambu finally overcame the unique anatomical challenges posed by the pediatric airway. For prehospital providers, whether it's trying to obtain an airway or as a rescue device when things don't go as planned, the King LTS(D) is now available when it is needed the most – for the tiniest of patients.

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