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J Korean Soc Emerg Med > Volume 31(6); 2020 > Article
Journal of The Korean Society of Emergency Medicine 2020;31(6): 534-542.
Comparison of tracheal intubation with direct laryngoscope using an assistive technique for novice: a manikin study
Jun Hyeok Won1, In Hye Kang2, Young Hwa Kim2 , Yong Hwan Kim1, Jun Ho Lee1 , Kwang Won Cho1, Seong Youn Hwang1 , Dong Woo Lee1
1Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
2Department of Emergency Medical Technology, Kyungil University, Gyeongsan, Korea
Correspondence  Dong Woo Lee ,Tel: 055-233-6140, Fax: 055-233-6134, Email: calmriver@daum.net,
Received: April 30, 2020; Revised: July 11, 2020   Accepted: July 20, 2020.  Published online: December 30, 2020.
Tracheal intubation is an essential procedure in many emergencies. Direct laryngoscopy is the best method of intubation, but its success is not assured in a difficult airway. This study was designed to compare the performance of two intubation-assisted maneuvers that can help an unskilled person to perform a successful intubation.
A randomized crossover trial for intubation was conducted in three airway scenarios: normal airway, tongue edema (TE) and cervical immobilization (CI). Sixty paramedic students performed intubation on a manikin using single operator intubation (SM), external laryngeal manipulation (ELM), and colleague assisted laryngoscopic maneuver (CALM). The degree of the visual field, intubation success rate, time to ventilation (TTV), tooth fracture, and difficulty of intubation were measured.
There was no statistically significant difference in success rates between the three intubation methods, except in CI, where CALM had a significantly higher success rate (91.7%) as compared to ELM (78.3%) and SM (71.7%). There was no significant difference in TTV between the three intubation methods in all scenarios. However, with an improvement in the degree of visual field with ELM and CALM, evaluated using the Cormack-Lehane classification system, there was a statistically significant improvement in both TE and CI. Tooth fractures were lowest when CALM was used. The degree of difficulty felt by operators during intubation also tended to be lower in CALM than other methods, particularly, in CI.
For a novice, intubation using CALM was on par or better than ELM in the manikin study. And CALM was a more effective assistive method, specifically in CI cases.
Key words: Intubation; Direct laryngoscopy; External laryngeal manipulation; Colleague assisted laryngoscopic maneuver
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