Abstract
Background
Patients arriving at the emergency department with a potential cervical spine injury
and immobilized in a rigid cervical collar often require emergency airway management
and rapid sequence induction intubation (RSII). There have been several advances in
airway management with the advent of channeled (AirtraqⓇ; Prodol Meditec) and nonchanneled (McGrathⓇ; Meditronics) video laryngoscopes, which enable intubation without the removal of
the cervical collar, but their efficacy and superiority over conventional laryngoscopy
(Macintosh) in the presence of a rigid cervical collar and cricoid pressure have not
been evaluated.
Objective
Our aim was to compare the channeled (Airtraq [group A]) and nonchanneled (McGrath
[Group M]) video laryngoscopes with a conventional laryngoscope (Macintosh [Group
C]) in a simulated trauma airway.
Methods
A prospective randomized controlled study was conducted in a tertiary care center.
Participants were 300 patients requiring general anesthesia (American Society of Anesthesiologists
class I or II), of both sexes, and aged 18–60 years. Airway management was simulated
without removal of a rigid cervical collar and using cricoid pressure during intubation.
After RSI, patients were intubated with one of the study techniques according to randomization.
Intubation time and Intubation Difficulty Scale (IDS) score were noted.
Results
Mean intubation time was 42.2 s in group C, 35.7 s in group M, and 21.8 s in group
A (p = 0.001). Intubation was easy in group M and group A (median IDS score of 0; interquartile
range [IQR] 0–1 for group M and median IDS score of 1; IQR 0–2 for group A and group
C; p < 0.001). A higher proportion (95.1%) of patients had an IDS score of < 1 in group
A.
Conclusions
The performance of RSII with cricoid pressure in the presence of a cervical collar
was easier and more rapid with channeled video laryngoscope than with other techniques.
Keywords
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Article info
Publication history
Published online: December 21, 2022
Accepted:
December 13,
2022
Received in revised form:
October 26,
2022
Received:
June 24,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
