The Korean Journal of Emergency Medical Services (한국응급구조학회지)

The Korea Society of Emergency Medical Services (한국응급구조학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of bimanual laryngoscopy, backward-rightward pressure, and cricoid pressure in difficult airway management: A manikin study

어려운 기도를 가진 마네킹에게 양손후두경법, 우측-후방압박법과 반지연골압박법 효율성 비교

  • 최혜경 (을지대학교 응급구조학과) ;
  • 정형근 (을지대학교 응급구조학과)
  • Received : 2014.06.24
  • Accepted : 2014.08.18
  • Published : 2014.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to establish novice user guidelines for efficient external laryngeal manipulation for intubation in difficult airway management. Methods: This study included 59 pre-qualified junior and senior emergency medical service students. The participants were instructed at random to intubate a manikin equipped with a cervical collar, thus simulating a difficult airway, using three types of external laryngeal manipulation: bimanual laryngoscopy, backward-rightward pressure, and cricoid pressure. The resultant intubation time and glottic view grade scores were estimated. Results: Intubation time was longest using the bimanual manipulation method, followed by cricoid pressure and backward-rightward pressure. A low Cormack-Lehane glottic view score was obtained regardless of the assisted compression method used. Conclusion: Backward-rightward pressure may be the most efficient method of external laryngeal manipulation on the basis of the intubation time and improvement in glottic view.

Keywords

References

  1. Falcone RE, Herron H, Dean B, Werman H. Emergency scene endotracheal intubation before and after the introduction of a rapid sequence induction protocol. Air Med J 1996;15(4):163-7. https://doi.org/10.1016/S1067-991X(96)90024-3
  2. Brenner BE, Kauffman J. Reluctance of internists and medical nurses to perform mouth-to-mouth resuscitation. Arch Intern Med 1993;153:1763-9. https://doi.org/10.1001/archinte.1993.00410150041004
  3. Hew P, Brenner B, Kauffman J. Reluctance of paramedics and emergency medical technicians to perform mouth-to-mouth resuscitation. J Emerg Med 1997;15:279-84. https://doi.org/10.1016/S0736-4679(97)00006-1
  4. Kovacs G, Bullock G, Ackroyd-Stolarz S, Caine E, Patrie D. A Randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance. Ann Emerg Med 2000;36(4):301-9. https://doi.org/10.1067/mem.2000.109339
  5. Sakles JC, Laurin EG, Rantapaa AA, et al. Airway management in the emergency department:A one-year study of 610 tracheal intubation. Ann Emerg Med 1998;31(3):325-32. https://doi.org/10.1016/S0196-0644(98)70342-7
  6. Tayal VS, Riggs RW, Marx JA, et al. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med 1999;6(1):31-7. https://doi.org/10.1111/j.1553-2712.1999.tb00091.x
  7. Benumof JL. Difficult laryngoscopy: Obtaining the best view. Can J Anaesth 1994;41(5):361-5. https://doi.org/10.1007/BF03009856
  8. Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anesthesia. Lancet 1961;2:404-6.
  9. Ovassapian A, Salem MR. Sellick's maneuver: To do or not do. International Anes-thesia Research Society 2009;109(5):1360-2.
  10. Knill RL. Difficult laryngoscopy made easy with a "BURP". Can J Anaesth 1993;40(3):279-82. https://doi.org/10.1007/BF03037041
  11. Takahara O, Kubata M, Mamiya K, et al. The efficiency of the "BURP" maneuver during a difficult laryngoscopy. Aneath Analg 1997;84(2):419-21. https://doi.org/10.1213/00000539-199702000-00033
  12. Benumof JL. Difficult laryngoscopy:Obtaining the best view. Can J Anaesth 1994; 41(5):361-5. https://doi.org/10.1007/BF03009856
  13. Hwang JY, Park SH, Huh J, Kim JH, Kim KS, Oh A, Han SH. Optimal external laryngeal manipulation: Modified bimanual laryngoscopy. Am J Emerg Med 2013;31(1):32-6. https://doi.org/10.1016/j.ajem.2012.05.016
  14. Brimacombe JR, Berry AM. Cricoid pressure. Anaesth 1997;44(4):414-25.
  15. Li CW, Xue FS, Xu YC, Liu Y, Mao P, Liu KP et al. Cricoid pressure impedes insertion of, and ventilation through, the ProSeal laryngeal mask airway in anesthetized, paralyzed patients. Aneath Analg 2007;104(5):1195-8. https://doi.org/10.1213/01.ane.0000260798.85824.3d
  16. Levitan RM, Mickler T, Hollander JE. Bimanual laryngoscopy: A videographic study of external laryngeal manipulation by novice intubators. Ann Emerg Med 2002;40(1):30-7. https://doi.org/10.1067/mem.2002.125716
  17. Richard ML, Wiilam CK, William JL, Worth WE. Laryngeal view during laryngoscopy: A randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Ann Emerg Med 2006;47(6):548-5. https://doi.org/10.1016/j.annemergmed.2006.01.013
  18. Samuel N, Winkler K, Peled S, Krauss B, Shavit I. External laryngeal manipulation does not improve the intubation success rate by novice intubators in a manikin study. Am J Emerg Med 2012;30(9):2005-10. https://doi.org/10.1016/j.ajem.2012.01.010
  19. Kang JH, Kang BS, Kang HG, Cho YS, Lim TH, Choi HJ, Park SH. Factors related to successful endotracheal intubations with glidescope(R). The Korean society of Emerg Med 2012;23(5):624-31.
  20. Garrad A, Campbell AE, Turley A, Hall JE. The effect of mechanically-induced cricoid force on lower esophageal sphincter pressure in anaesthetised patients. Anaesth 2004;59(5):435-9. https://doi.org/10.1111/j.1365-2044.2004.03682.x
  21. Turgeon AF, Nicole PC, Trepanier CA, et al. Cricoid pressure does not increase the rate of failed intubation by direct laryngoscopy in adults. Anaesthesiol 2005;102(2):315-9. https://doi.org/10.1097/00000542-200502000-00012
  22. Roberts JT, Ali HH, Shorten GD. Using the bubble inclinometer to measure laryngeal tilt and predict of difficult of laryngoscopy. J Clin Anesth 1993;5(4):306-9. https://doi.org/10.1016/0952-8180(93)90124-W
  23. Snider DD, Clarke D, Finucane BT. The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure. Can J Anesth 2005;52(1):100-4. https://doi.org/10.1007/BF03018589