Upper cervical spine movement during intubation with different airway devices

• Published in: The American journal of emergency medicine 2013-07, Vol.31 (7), p.1034-1036
• Main Authors: Kılıç, Taylan, MD, Goksu, Erkan, MD, Durmaz, Dilek, MD, Yıldız, Günay, MD
• Format: Article
• Language: English
• Subjects: Airway management; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - physiology; Cineradiography; Emergency; Emergency medical care; Humans; Intubation; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - instrumentation; Intubation, Intratracheal - methods; Laryngeal Masks - adverse effects; Laryngoscopes - adverse effects; Larynx; Spine; Studies; Vertebrae
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.03.029

Abstract Prevention of secondary neurologic injury is critical during the airway management of a trauma patient. Trauma patients are assumed to have an unstable cervical spine (C-spine) until proven otherwise: orotracheal intubation during airway management may result in a certain amount of C-spine movement. This study, therefore, aimed to compare C-spine movement within different advanced airway devices (Macintosh blade, McCoy Blade, LMA, I-LMA, and Combitube) during airway management. Materials and Methods A total of 3 fresh frozen cadavers were used. The cadavers were consecutively intubated by 4 different postgraduate year residents with LMA4, I-LMA5, Combitube (37F), Macintosh 3, and McCoy blades. The cinefluoroscopic view of the entire intubation process was recorded, and vertebral body angles were calculated. Results At the C0C1 level, compared with the McCoy laryngoscope (median, 7°), the LMA (median, 2.5°) and the Combitube (median, 1.5°) caused less extension of the cervical vertebra. In addition, the Combitube (median, − 1°) and the I-LMA (median, − 2°) caused less extension of the C2C3 region when compared with the Macintosh laryngoscope (median, 3°). There was no significant difference between groups at the C1C2, C3C4, and C4C5 segments. Conclusion Supraglottic devices used during airway management cause C-spine movement less or equal to conventional laryngoscopes. Furthermore, because of ease of training and blind insertion, supraglottic devices can be safely used with trauma patients when C-spine integrity is a concern.