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A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway

Published online by Cambridge University Press:  06 April 2017

Christopher Stein ,
Louis Gerber ,
Denis Curtin ,
Nicole Oberem  and
Mike Wells
Christopher Stein*
Affiliation:
Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
Louis Gerber
Affiliation:
Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
Denis Curtin
Affiliation:
Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
Nicole Oberem
Affiliation:
Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
Mike Wells
Affiliation:
Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
*
Correspondence: Christopher Stein, PhD Department of Emergency Medical Care Faculty of Health Sciences University of Johannesburg P O Box 524, Auckland Park Johannesburg 2006 South Africa E-mail: cstein@uj.ac.za
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Abstract

Aim

The goal of this study was to compare the relative effectiveness of three adjunctive maneuvers – head elevation (HE), forward laryngoscope traction (FT), and external laryngeal manipulation (ELM) – on laryngoscopic view, intubation time, and intubation success performed by a sample of novice intubators using a simulated airway.

Methods

Twenty-two second year university paramedic students were required to perform laryngoscopy and intubation on a simulator four times on two separate days. The first day involved intubation using no adjunctive maneuvers (control) plus HE, FT, and ELM in random order in a normal simulated airway. A similar approach was used on the second day, but the simulator was configured to have a difficult airway. Percentage of glottic opening (POGO) scores, intubation time, and intubation success were measured for all intubation attempts.

Results

Head elevation was found to be the most effective adjunctive maneuver in the normal airway, increasing the mean POGO score from control by 27% (P=.002), while ELM was most effective in the difficult airway, increasing the mean POGO score by 21% (P=.009) and the proportion of successful intubations by 41% (P<.001). All maneuvers decreased intubation time in the normal and difficult airway and were associated with significant differences in intubation success compared to control in the difficult airway.

Conclusions

This study identified HE as the most effective maneuver for improving laryngoscopic view in a normal airway and ELM as the most effective in a difficult airway in a group of novice intubators.

SteinC, GerberL, CurtinD, OberemN, WellsM. A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway. Prehosp Disaster Med. 2017;32(4):419–423.

Keywords

airway managementendotracheal intubationlaryngoscopy
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 4 , August 2017 , pp. 419 - 423
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest: The authors declare no conflicts of interest.

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