08/27/2026
Three cardiac arrest patients. Three King LTs placed on the first attempt. Three perforated hypopharynxes found on postmortem CT.
Why it matters: In all three cases, breath sounds were documented as normal. Insertion was described as easy. Nothing at the scene said anything was wrong.
The findings (Prehospital Emergency Care, Maniwa et al.):
All three patients developed extensive subcutaneous emphysema. Two had pneumothorax, one a tension pneumothorax with mediastinal shift.
CT showed the tube deviated anterolaterally off the esophageal axis in each case. The suspected culprit: the piriform recess, a lateral pocket that can trap the tube tip during off-midline insertion.
The takeaway: Auscultation confirms nothing. First-pass success confirms nothing. Continuous waveform capnography is the only thing that tells you where the gas is actually going, and subcutaneous emphysema after insertion is a red flag, not a curiosity.
Insert midline. If you meet resistance, stop. Do not repeat a blind attempt.
These three were found only because both hospitals routinely perform postmortem CT. Most systems do not. Which raises the real question: how often is this happening and never discovered?
๐ Read the full study:https://media.handtevy.com/website/Hypopharyngeal-Perforation-Associated-with-King-Laryngeal-Tube-Use-in-Prehospital-Cardiac-Arrest-Management.pdf