You might remember Minh Le Cong from the needle vs. the knife – part I podcast. He is a retrieval (EMS) physician from down under and he has a particular interest in prehospital airway management. He was kind enough to review the king vision video laryngoscope for the blog. Neither Minh nor myself have any conflicts of interest with this company. This is the device that Cliff Reid has been keen on as well. If you are an ED doc in a shop that doesn't have difficult airway equipment, this would seem the ideal device to buy for yourself as well. Now on to Minh's review…
Brief Review of the King Vision Video Laryngoscope
by Dr Minh Le Cong
Introduction
The King Vision video laryngoscope is the latest in a long series of devices that claim to provide the “perfect view” for intubation via use of video and digital technology. I chose to purchase one to test it, having personally reviewed a number of the major players earlier this year at an airway conference in Australia. I am a rural generalist medical practitioner working in Cairns , Queensland, Australia for the Royal Flying Doctor Service, the longest continuously running aeromedical service in the world. My primary medical specialist training was in rural and remote medicine with subspecialty training in emergency medicine and internal medicine. My clinical work is a mix of aeromedical retrieval and remote medicine. I was not sponsored by anyone to write this review and purchased the device for personal use.
The design
The King Vision Video laryngoscope is a two piece design. It has a reuseable monitor that attaches to disposable blades. In some respects this is a similar approach to the Pentax Airway Scope which has a reuseable monitor and disposable blades. Where the King Vision differs is that the LED light and CMOS camera are mounted on the disposable blades. This makes the design simpler to use as you essentially just have to connect the two pieces together by simply sliding them into each other.
The blades are all Macintosh #3 size and compared to a normal Macintosh #3 bladed laryngoscope, the King Vision blades appear wider and shorter. There are blades with a guiding channel and standard blades without. Both only come in #3 size though .The guide channel blade is very similar to the Pentax and Airtraq blade designs. . When you use the device you quickly come to the conclusion that all you will need is a #3 size blade.
The display is an OLED design of surprisingly good clarity and resolution when you consider the pricing of the device ( see Cost section below). It is turned on with a single power button on the back of the display and turned off by depressing it for 3 seconds. It is certainly a no frills design which makes it simple to understand and use. There is no brightness adjustment nor in built video recording function. There is a mini USB port for a video out function to either a display or digital recorder. The LED light on the blade tip is very good with nice intensity and a pale white illumination. The device is powered by standard AAA size batteries x 3 and is rated to last at least 90 minutes or greater.
Performance
My colleagues and I tested the device using a Trucorps Air Sim intubation mannikin, using size 6 and 7.5 cuffed endotracheal tubes as well as a Frova bougie. We compared it to direct laryngoscopy with a Macintosh #3 blade. We tested using standard intubating conditions and simulated difficult intubation by inflating the mannikin tongue to simulate swelling and upper airway obstruction. We conducted the testing indoors with normal fluorescent tube lighting and then outdoors in midday sunlight. As expected in the simulated difficult intubation the King Vision performed significantly better than direct laryngoscopy, both in terms of laryngeal visualization but also speed and success of intubation. There were some initial learning issues with passing the tracheal tube via the guide channel but these were quickly mastered within 3 practice intubations.
[click images to see full size]
The finding that most impressed me about the King Vision was using a bougie with it. You can use the bougie with or without the aid of the guide channel and getting the tip pass the cords is much easier using the video laryngoscope. Then passing the ETT over the bougie under video guidance is a major advantage as you can see how the tip of the ETT catches on the right arytenoids.
[click images to see full size]
Okay those images were of course of the indoors testing. Here are the results of the outdoor testing. Remember this is relevant for the prehospital work we do in RFDS as sometimes you are outdoors doing RSI at a cattle station for someone who has fallen off a horse and sustained a severe head injury!
Here is my colleague Dr Shaun Parish, performing the testing outdoors. Note the bright sun light. Direct larynogoscopy interestingly performed fairly well in this testing which is probably because we did not have the mannikin directly on the ground. When trying to intubate a person flat on the ground with bright sunlight we have usually found this quite difficult due to the glare of the sun into the field of view particularly if directly coming from behind. The King Vision performed well even in this brightly sunlit setting with little difference to performance indoors. It was difficult to get a good picture of the LED screen view during intubation so the best I could do was take out the King Vision and point it at an object and take this photo in direct sunlight from behind. You can see the image although degraded and washed out of colour is still an effective resolution with clearly discernible structures.
[click images to see full size]
Now there has been one published study finding the Pentax AWS screen does not perform well in bright outdoor conditions and I was aware of this so it surprised me that the King Vision was more capable in this setting.
Pricing and Overall package
The King Vision is sold by Critical Assist in Australia for the delivered price of $1100 approximately. This is what you get for that money.
A kit with the monitor display and 4 disposable blades ( 3 channeled and 1 standard). The monitor has a 1 year guarantee and the disposable blades can only be bought in boxes of 10 at $30each.
Bottom line for me
This is the best overall package for getting started in video laryngoscopy due to low pricing, quality imaging and simplicity of use. It is excellent I think for prehospital airway management having a display that performs well in outdoor testing. Its closest rival would be the AV laryngoscope distributed by LMA Pacmed in Australia but that costs approx $7000 each. Another close rival would be the Airtraq by Prodol which is cheaper and disposable but has the disadvantage of using a shielded eyepiece as the viewing display. With the King Vision you can maintain an overall view of the patient without having to lean down and peer into a black hole. Therefore you can maintain situational awareness and keep an eye on oxygen saturation monitor and cardiac rhythm as well as anterior neck and chest whilst getting that “perfect view”! I think the expense of previous video laryngoscopes has made most airway providers resist the jump into learning the skill of this new technique but now with the King Vision there is little barrier to make that leap of faith! It costs less than most airway courses!
- EMCrit 394 – CV-EMCrit – Inotrope Basics Part 2 – Specific Scenarios - February 7, 2025
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Glad to see you like it! Still working on getting those onto our trucks here.
Thanks to your advice Chris! Good luck arguing with the bean counters!
I would give the AirTraq another try. The eyepiece you describe in the article pops off and they have a video camera with screen that slides onto the blade and optics. It also has the advantage of a heated lense to avoid fogging (for us in the chilly areas) and it’s still very inexpensive.
Great post Minh, and also timely as it seems several of us rural docs in Oz are weighing up pros/cons of various adjuncts for our resus bay and for use at the roadside.
I wonder how well those Parket tip ETT would work with these devices? Less chance of holdup at the arytenoids?
Anyhow, off now to make a business case for having these in our local unit….although at the cost, I might just have to buy a brace myself for the prehospital bag.
Great review, thanks.
No problem Tim. Anything for a fellow rural doc. My sister in law has a house on Kangaroo Island and its nice to know if she ever gets into trouble out there, you and your prehospital bag will be ready !
Not used the Parker tip ETT but my favourite ETT for anything, especially with a bougie is the Fastrach ETT with the silicone soft tip and wire reinforcement. They are not cheap $70 each I think but worth the money.
Dear Minh, Thanks for your review. I got some questions for you: 1) How is the performance of King Vision scope in airway with soiling (e.g. secretions, blood). From my experience on using airtraq, its camera lens system cannot tolerate just slight more-than-average amount of secretion at the airway and the image from the eye piece was blurred quite often. I wonder if the King Vision scope would out-perform Airtraq in this aspect 2) Can we use the King Vision scope with non-channel blade like an ordinary direct laryngoscope? For e.g. we could use the C-MAC system like a regular… Read more »
Hi Duncan Does BR stand for Baton rouge? The prices I quote are in Australian dollars I would not use any VL as a normal laryngoscope . I would have a good VL and DL separately in the prehospital setting. In Hospital you could just use one system for both but almost no one does as far as I know. Remember the King vision only comes with #3 Mac blades and even they appear shorter and wider than regular #3 Mac blades. If all you had was the King vision then of course you could use it for DL and… Read more »
Dear Minh,
Thanks for your reply. BR stands for “Best Regards”…sorry for my laziness. I’m actually coming from Hong Kong
I also tried passing suction catheter alongside the lumen of the ET tube mounted on airtraq trying to savage poor view because of secretions, but it was unsuccessful.
Re : soiled airway
I wonder? Non-channelled blade on the KingVision and the ETT-stylet-meconium aspirator- suction contraption described in preceding post. Might work a treat.
Better to fix a soildd airway than deal with soiled underwear, my first rule of the trauma airway.
Or maybe even ETT suction setup with the aspirator, via the guided channel blade of the King Vision to protect camera from fluids and obviate need for stylet.
Intriguing possibility
Must build that simulated massive regurgitation and bleeding into airway mannikin idea I have been thinking of to test this!
Any issues with the lens fogging up? When we demo’d the mcgrath we found the lens fogged up prehopsital due to temperature difference in regards to storage then temperature increase in the oral cavity.
Great question Jeremy
You don’t think of these things when you are living in the tropics!
We did more testing today and it was hot and humid outside..so from the cool air conditioning inside to testing outside we did not notice a difference
I will try to test this further by cooling the device in the fridge then testing outside again on hot humid day and let you know..it’s supposed to have an antifog coating on the camera
re: lens fogging
Well, I’m down in the south of Australia (rural NSW currently) and so far fogging hasn’t been a problem. Last night took KingVision from car to a case at 11pm – outside temperature about 5 degrees Centigrade. KingVision on for about 15 seconds before intubated. No problems. So based on n=1, this kit still gets thumbs up.
Intrigued by Minh’s proposal of a massive regurgitation/bleeding into airway mannikin. Could be messy.
Just experimenting with hooking it up to a monitor. Got myself a cheap portable monitor from local hobby shop (TFT screen, colour, 12V power, 12″) and hooked it up to KingVision with the supplied composite video cable Sweet! Now have a device which means I can intubate and concentrate on the view in front of me via the screen inbuilt to KingVision handle…and my colleagues n theatre or resus can award points as they watch on the ‘big screen’ What I like best about this is that (a) can accelerate the learning curve for novices (b) with VL you can… Read more »
Minh just shared this image: https://emcrit.org/wp-content/uploads/2011/10/IMAG0514.jpg Minh States: there was a question about using the King Vision from cold into warm environment and fogging. I placed the king vision in the freezer for 5 minutes then I took it outside in the warm humid air of tropical Queensland. Ambient temperature today is about 30 deg C. I tested using a Trucorps mannikin again I attach a picture of the King Vision screen during this test. As you can tell no significant fogging. When the ambient temp reaches 36-37 C I can retest to try to simulate body temperature but this… Read more »
Quick update as I’ve had several people email me re : monitors to use with the KingVision and video out cable My hobby store monitor setup described earlier works well….and I’ll get the maintenace lads at our small rural hospital to secure it to an IV pole and setup a 12v power supply for the monitor. Just down in Sydney, NSW on Paul Baker’s excellent airway skills course….put the KingVision head-to-head with the McGrath VL – whilst the latter has an adjustable screen, it is more expensive and the portrait vs landscape screen orientation didnt work for me. Also no… Read more »
This product looks great for any video system with outputs–thanks for the tip Tim. Video Capture Device
This device is mediocre at best. It doesn’t stand up well to blood/vomit in airway and the blade is very flimsy is you give it much lift. I don’t see it being able to stand up to how rough we are on our equipment. I wasn’t impressed with Airtraq and this isn’t that much different. “Cheap” isn’t always the lowest cost or best thing for the
patient. It bothers me that medicine has gotten away from using what is best.
Sandy-
This has not been my experience during my trial. These devices are not made to lift the airway structures as you do with a conventional laryngoscope.
Also, would you mind letting us know if you have any conflicts of interest.
Much thanks,
Scott
I had the opportunity to try this device in an airway lab today and while at first skeptical, I was impressed. Granted there are several differences between a mannequin and a human being, but the concept is there. I am curious to hear about someone who may use it in a blood/emesis airway. As stated above, from my understanding this device is not made to actually manipulate structures. It simply slides down the base of the tongue. I did however, notice that occasional slight upward-leftward pressure was required to manipulate the ETT around the right arytenoids. I am told that… Read more »
Sandy, thanks for your feedback. Have you actually tested the device in any manner at all? I ask because on further testing of the device in terms of the simulated bloody airway, comparing it to the AirTraq, a colleague and I found there appeared to be an advantage with the King Vision. OUr results I believe , will be posted on this site soon so check it out for yourself. The Airtraq I find is a good device for the cost but it failed our simulated bloody airway testing. I agree we should always try to use good quality equipment… Read more »
We trialled the King Vision at the RBWH in the Anaesthetic Dept. The following was fed back to the administration. Both the channeled guided and standard (or non-channeled) blades were trialled. The optics are are excellent and the video image is high quality. This aspect places the device in front of many currently marketed devices in this field. The significant fault with the device was its length. The device’s screen repeatedly struck the anterior wall of the patient’s chest in patients with retrognathia, large barrel-shaped chests or who required manual in-line stabilisation of the neck. The device could not be… Read more »
Keith,
2 solutions possible:
The device can be inserted with 90 rotation and then rotated back after the blade is mostly into the mouth–i do the same with my cmac
with the king, you can insert the blade without the screen and only then attach the screen portion
Hi Minh, I have been following your blog for some time. Very informative. I just got hold of a kingvision and have been trying it in all of my patients. I practice in a charity hospital and the idea of disposing the blade after a single use is not a good idea. We just clean and sterilize it with cutasept. My problem is that every time I use it the lens always fogs up. Does using the blade several times has something to do with this. Another thing I observe is that there is difficulty in passing the tube in… Read more »
thanks for questions Nelson yes the single use blades will fog up after cleaning as the antifog film on the camera eye gets washed off. thats why they are single use! I would advise you review your practice/policy of reusing these single use blades. as for the problem of a channeled blade guiding ETT too anterior if patient in sniffing position, it might be because you got the blade inserted too deeply. generally withdrawing the blade a bit may reposition angle better. ideally if you have it a pair of macgills forceps will allow you to redirect ETT much easier… Read more »
Hi Keith! Keith is a senior Anaesthetic consultant and one of the current principal members of the ANZCA Airway SIG. He runs an airway wet lab in Brisbane. hope to see you there in April, mate! I was privileged to host both Keith and Richard Levitan at an airway course in Cairns a couple of years ago and had the rare opportunity to hear both of them talk airway management over dinner. Two masters debating things like airway research methodology and cricoid pressure..golden stuff! About the length of the King Vision, I agree we have found the same thing in… Read more »
Hi Minh,
A great review of the King Video Larygoscope. Could u drop me an email as to where i could buy it from? my email is drchan@flindersema.com
thanks
Kevin U. Chan
I’d like to purchase tge King video scope. Did you get a website or contact for purchasing one?
Please share info. via my email.
Thank you!
please send purchasing info to my email address is: roadrun1@sbcglobal.net
The department I work for just purchased these for a primary airway access with ETT. Upon initial training and practice, one would indicate this is the easiest way to achieve an ETT airway where ever your at. Initially I was impressed with this. I did have some reservations in the back of my mind, but was anxious to get an opportunity to use it. It sucks for traumatic airways or airways where there is extensive vomit or blood. What are you going to do, wipe the camera on your shirt when it becomes red like blood? I knew it was… Read more »
We’ve been using the King Vision as our video laryngoscope for our critical care air and ground teams (Metro Life Flight). We are almost exclusively using it when DL has failed or in an anticipated difficult intubation. It is really important to realize that there is no ideal intubation device. There will always be situations where one option is superior to another. I don’t necessarily think this is about inventing the better mousetrap but rather a reflection of the diversity of difficult airway issues. Note that in Glidescope trials I’ve read the number one rescue device was DL. There are… Read more »
Hi Scott,
what is ED intensivist?
Just a quick comment from Perth Australia. I would like to highlight that this is a true indirect laryngoscope. It is not in my opinion designed to be used as a MAC 3 blade for direct laryngoscopy. It’s not a tissue lifter as such but it is a only a slider. (I know you have to lift sometimes when you are in but that is not to align the axis) If your airway skills are through years of practice and patient experience with a standard macintosh blade, using an indirect blade as your first line is I think a dangerous… Read more »
Dr. Heard, First, let me say it is with great pleasure that I see you posting a comment on the blog. (For those who don’t know, Dr. Heard has done extensive work on difficult airway management and I highly recommend his papers and courses.) I agree with all you have written above. To your point re: US folks–I would say Glidescope has stormed the market, at least initially. Most depts that have bought video scopes have glidescopes. I think the transition from glidescope to king is much easier than from conventional laryngoscopes just as you elude to. We have the… Read more »
Hey Scott
Having had a frustrating time with a three hour turnaround on cleaning of our CMAC size 3 blade yesterday, as I intubated the third patient in a row who that size would have been ideal for, I was wondering if you had heard any more about the disposable blades from Storz? A google search just finds your blog post really! Thanks mate
d
Any comparison between channelled and standard blade? How is the device holding up (ease of use, durability and usefulness) a year + in the real-life condition?
Pitfalls, limitation, tips? I gather the blade is $30 each, do box of 10. = ~$ 300?
Hello all! Some observations… First, we are a paramedic EMS service with just under 10,000 runs a year. We tested the King and the McGrath Mac side by side over 2 days with a cadaver. The meds prefered the King 2 to 1 over the McGrath, but it appears that was mostly based on the quality of the video. The cadaver was mostly clean and dry other than surgilube for insertions. The camera held up well with 70+ intubations using a single blade! I was impressed with the durability, as we meds can be brutal on equipment! My instruction on… Read more »
Our paramedic service has adopted the King Vision as the primary device for all adult intubations. We have over 100 intubations with it now and our experience has suggested several tips for successful use. 1). We practice inserting the blade without the camera for those large patients or those with continuous compressions ongoing. This works well once practiced. 2). We train to visualize the epiglottis prior to passing the tube. I started teaching this instead of telling them to use it as a Mac when I realized saying it this way worked better. Our medics were almost always thrilled with… Read more »
Fantastic tips!
This is a great device! I found some more information on this website: http://www.medicalexpo.com/medical-manufacturer/laryngoscope-956.html
http://iero7.com/2015/09/27/brief-review-of-review-of-the-king-vision-video-laryngoscope/
I cannot get the light to come on anymore .
I changed the 3 triple A batteries .. The screen lights up when I press the power button .. it stays on for about a minute … I have repeatedly adjusted the batteries for better connectivity..
Any suggestions .. pls advise..
Many thanks
Mary Lou Guillot, CRNA , FNP-C
These medical apparatus guide is really helpful for vets. https://gujratsteel.com/product-category/metwood/