Comparison of Cervical Spine Movement by Airway Equipment during Orotracheal Intubation: A Manikin Pilot Study / 대한구급학회지

BACKGROUND: In patients with limited cervical spine movement, equipment for orotracheal intubation should achieve sufficient laryngeal exposure with the least cervical spine movement. This study was designed to compare movement of the cervical spine during the orotracheal intubation with various intubating equipment. METHODS: Twelve emergency physicians & residents with a total experience of >50 cases of endotracheal intubation in two emergency centers were assigned to perform orotracheal intubation with four different airway devices, including the Macintosh laryngoscope (ML), DCI video laryngoscope (DCI), Airway Scope (AWS) and Levitan Scope (LS), using the same manikin (Ambu(R) airway management trainer) in random sequences. Movement of the C-spine was examined by measuring the angle formed by two lines which are parallel to the anterior surface of the C2 and C7 vertebrae bodies. The angle was measured when Cormack-Lehane grade II glottis exposure was achieved during intubation. RESULTS: Mean cervical spine movements were 37.6 +/- 9.2degrees, 32.2 +/- 14.2degrees, 32.2 +/- 6.45degrees and 17.4 +/- 10.0degrees with the ML, DCI (p = 0.347), AWS (p = 0.094), and LS (p < 0.001), respectively, compared to that of ML. Cervical spine movement by LS was 54% less than that by ML. LS produced less cervical spine movement in comparison to DCI (p = 0.013) and AWS (p = 0.001). CONCLUSIONS: The Levitan Scope produced less movement of the cervical spine when compared to the Macintosh laryngoscope, DCI video-laryngoscope and Airway Scope during orotracheal intubation in a single airway training manikin model.

The Parameters Affecting the Success Rate for Endotracheal Intubation in Emergency Department: Multi-center Trial using Korean Emergency Airway Management Registry

PURPOSE: To determine the parameters affecting the success rate for endotracheal intubation in emergency department (ED) of teaching hospitals in the metropolitan area of Korea. METHODS: This was a prospective observational study in six teaching hospitals. From February 25 to August 31, 2006, physicians performing intubations at six university-affiliated EDs in the Seoul metropolitan area completed a data form from which data were entered into the Korean Emergency Airway Management Registry (KEAMR). Data were abstracted from KEAMR and analyzed. RESULTS: A total of 703 intubations were registered over this period with overall success rate of 78.2%. As indicated by univariate analysis, endotracheal intubation was most successful when the glottic exposure grade (GEG) was lower (p<0.001), the specialty of the intubator was emergency medicine (p<0.001), the level of training was higher (p<0.001) and the intubation method was rapid sequence intubation (p=0.039). In logistic regression analysis, GEG, specialty of the intubator, and level of training were related to success rate. But no significant differences were shown among the intubation methods. CONCLUSION: Success rates for endotracheal intubation in emergency departments of teaching hospitals in the Seoul metropolitan area were related to GEG, specialty of the intubator, and level of training.