Airway Scope Laryngoscopy Under Manual Inline Stabilization and Cervical Collar Immobilization: A Crossover In Vivo Cinefluoroscopic Study

Abstract

When compared with cervical collar immobilization, AWS laryngoscopy along with MIS seems to be a safer and more definite method to secure airway of neck-injured trauma patients because it limits less mouth opening and upper cervical spine movement.

Successful tracheal intubation with the McGrath® MAC video laryngoscope after failure with the Pentax-AWS™ in a patient with cervical spine immobilization

“…Then again, the Pentax-AWS may also have some limitations for intubation because failed tracheal intubations using the Pentax-AWS have been reported in patients with a long distance from the mouth to the larynx and with a smaller mouth opening. 4,5 We also failed to intubate this patient's trachea using the Pentax-AWS, probably because of the relatively short interincisor distance (30 mm) and the long thyromental distance (85 mm). …”

Effect of rigid cervical collar on tracheal intubation using Airtraq®

“…[2] There was a wide and unpredictable variation between subjects in the reduction in mouth opening and a significant proportion were reported to have inter-incisor distance of 20 mm or less in the presence of rigid cervical collar. [81214] In a report by Aoi et al ., 7 of 9 failed cases in the study had Inter Incisor distance < 10 mm which was insufficient to insert the 18 mm blade of airway scope. [12] In the present study, insertion of Airtraq ® was possible in all patients despite restriction of mouth opening.…”

“…[81214] In a report by Aoi et al ., 7 of 9 failed cases in the study had Inter Incisor distance < 10 mm which was insufficient to insert the 18 mm blade of airway scope. [12] In the present study, insertion of Airtraq ® was possible in all patients despite restriction of mouth opening. The recommended mouth opening for no.…”

“…[9] These problems were probably caused by the neck collar strap under the chin lifting up and tipping the larynx anteriorly. In a study by Aoi et al .,[12] using the airway scope, intubation failure is reported in 30% of the cases in collar group whereas only 3.3% of the cases with MILS. The difficulty resulted from limitation of mouth opening.…”

“…Several devices that facilitated intubation in neutral neck position were found to perform poorly in the presence of the cervical collar when compared to its removal. [9101112] The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq ® has not been evaluated. We, therefore, tested the hypothesis that the Airtraq ® allows tracheal intubation in the presence rigid cervical collar with similar ease as intubation in its absence.…”