Hypopharyngeal Perforation Associated with King Laryngeal Tube Use in Prehospital Cardiac Arrest Management.

Abstract

Objectives: To describe three cases of suspected hypopharyngeal perforation after prehospital King laryngeal tube placement and to highlight clinical features associated with this rare complication.

Methods: We report three out-of-hospital cardiac arrest cases in which postmortem computed tomography identified findings suggestive of hypopharyngeal perforation after King laryngeal tube insertion by emergency medical services clinicians.

Results: All three patients developed extensive subcutaneous emphysema, and two had pneumothorax. Postmortem computed tomography showed anterolateral device deviation from the esophageal axis. Serial capnographic data were unavailable after placement, but arterial blood gas analyses showed severe acidosis, hypercapnia, and hypoxemia.

Conclusions: Hypopharyngeal perforation is a rare but serious complication of prehospital King laryngeal tube placement. Subcutaneous emphysema after insertion should raise concern for upper airway injury or malposition, and continuous end-tidal carbon dioxide confirmation and monitoring may help earlier recognition of inadequate ventilation.