External laryngeal manipulation does not improve the intubation success rate by novice intubators in a manikin study☆
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Fig. 1
External laryngeal manipulation. The intubator guides the position and pressure exerted by the assistant's hand on the larynx to optimize glottic view.
Fig. 2
Study flow chart.
Abstract
Background
External laryngeal manipulation (ELM) is a technique used in cases of poor glottic view in direct laryngoscopy. Studies investigating ELM in the pediatric population are lacking. The objective of this study was to examine if use of ELM by inexperienced intubators improves the success rate of pediatric intubation.
Methods
We conducted a randomized, controlled, manikin study comparing intubation using ELM (study subjects) with standard intubation (controls). Study participants were paramedic students. Each participant performed 1 intubation attempt on 3 different pediatric airway manikins, independently. If an optimal Cormack-Lehane glottic view (CLGV) of more than 2 has been obtained, study subjects were previously instructed to perform the intubation using ELM; controls were instructed to continue with standard intubation. Outcome measures were single-attempt intubation success rate, preintubation CLGV, and duration of intubation.
Results
The study group included 13 subjects who performed 39 intubations. In 19 intubations, CLGV of more than 2 had been obtained; and ELM was used. The control group included 14 subjects who performed 42 intubations. In 20 intubations, CLGV of more than 2 was obtained. Median CLGV score improved from 3.5 before ELM to 2 when ELM was used. However, no difference was found between the groups in intubation success rate (10/19 vs 14/20, P = .43); and the duration of intubation was significantly shorter in controls (25.8 vs 37.8 seconds, P < .007).
Conclusions
In this pediatric manikin study, ELM performed by novice intubators improved laryngeal view, but lengthened the duration of intubation and did not improve intubation success rate.
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☆Author contributions information: N.S. conceived the idea for the study, designed the study, collected the data, and drafted the manuscript. K.W. assisted in creating the study design and in data collection. S.P. assisted in data collection. B.K. critically reviewed the manuscript. I.S. designed the study, drafted the manuscript, performed the statistical analysis, and reviewed the literature. I.S. has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
