Manual In-Line Stabilization for Acute Airway Management of Suspected Cervical Spine Injury: Historical Review and Current Questions

Manoach, Seth; Paladino, Lorenzo

doi:10.1016/j.annemergmed.2007.01.009

Cited by 107 publications

(55 citation statements)

References 49 publications

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“…Thus the efficacy and safety of MILS is far from established. 31 Nevertheless, MILS is currently considered a standard of care and is recommended by the American College of Surgeons when intubating patients with a suspected or confirmed cervical spine injury. 1 Although not designed to measure the success rate of tracheal intubation, four previous studies evaluated the effect of MILS on laryngoscopic view with a standard laryngoscope blade and yielded results in agreement with the present study.…”

Section: Discussionmentioning

confidence: 99%

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy.Results Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/ 105) in the control group (P \ 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 ± 8.5 sec and 8.7 ± 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI 95% 5.0-9.3, P \ 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. Conclusion In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy. RésuméObjectif Bien que la stabilisation manuelle en ligne (SMEL) soit fre´quemment utilise´e pendant l'intubation endotrache´ale chez des patients pre´sentant une instabilited e la colonne cervicale connue ou suspecte´e, l'effet de la SMEL sur l'intubation orotrache´ale est tre`s peu documente´e. Cette e´tude a e´value´le taux d'e´chec de l'intubation trache´ale dans un intervalle de temps fixe avec une SMEL. Méthode Deux cents patients devant subir des chirurgies non urgentes ont e´te´randomise´s en deux groupes. Dans le groupe SMEL, la teˆte du patient a e´te´stabilise´e dans une

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Section: Discussionmentioning

confidence: 99%

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Thiboutot

Nicole

Trépanier

et al. 2009

Can J Anesth/J Can Anesth

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“…But the standard practice of tracheal intubation in unstable cervical spine patients is to remove the anterior portion of the collar and intubate using manual in-line stabilization (MILS). 27 We do not suggest changing our normal practice of applying MILS and the use of said approaches in such patients. For this reason, we did not perform this study in patients with an unstable cervical spine, and further studies are required before we can arrive at such a conclusion.…”

Section: Discussionmentioning

confidence: 99%

A comparison between left molar direct laryngoscopy and the use of a Bonfils intubation fibrescope for tracheal intubation in a simulated difficult airway

Gupta

Thukral

Lakra

et al. 2015

Can J Anesth/J Can Anesth

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“…La SMEL demeure néanmoins quelque peu controversée, principalement parce que son effet sur le pronostic des patients n'a jamais été explicitement étudié et parce que sa capacité à réduire les mouvements cervicaux pendant la prise en charge des voies aériennes a été mise en doute. 17 Il n'en demeure pas moins qu'il a été clairement établi que la visualisation glottique était gênée par une SMEL et que celle-ci entrave considérablement l'intubation trachéale par laryngoscopie directe (LD) -mais pas autant que la combinaison collet / sac de sable / ruban adhésif / planche dorsale.…”

Section: Immobilisationunclassified

“…However, MILS remains somewhat controversial, chiefly because its effect on patient outcome has never been properly studied, and its ability to decrease cervical motion during airway management has been challenged. 17 It has been clearly established that MILS impairs glottic visualisation, 18 and it significantly hinders tracheal intubation with direct laryngoscopy, 19 although not to the same extent as the collarsandbag-tape-backboard combination. 20 …”

Section: Airway Managementmentioning

confidence: 99%

Airway management in the patient with potential cervical spine instability: Continuing Professional Development

Robitaille

2011

Can J Anesth/J Can Anesth

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Manual In-Line Stabilization for Acute Airway Management of Suspected Cervical Spine Injury: Historical Review and Current Questions

Cited by 107 publications

References 49 publications

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

A comparison between left molar direct laryngoscopy and the use of a Bonfils intubation fibrescope for tracheal intubation in a simulated difficult airway

Airway management in the patient with potential cervical spine instability: Continuing Professional Development

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