Cervical spine movement during orotracheal intubation

Majernick, Thomas G; Bieniek, Russell; Houston, John B.; Hughes, Howard G.

doi:10.1016/s0196-0644(86)80178-0

Cited by 186 publications

(58 citation statements)

References 12 publications

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“…138,139 For victims with suspected spinal injury, rescuers should initially use manual spinal motion restriction (eg, placing 1 hand on either side of the patient's head to hold it still) rather than immobilization devices (Class IIb, LOE C 141,142 ). Spinal immobilization devices may interfere with maintaining a patent airway, 143,144 but ultimately the use of such a device may be necessary to maintain spinal alignment during transport.…”

Section: Open the Airway: Healthcare Providermentioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

697

495

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Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:• Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing (ie, the victim is not breathing or only gasping) Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world. 1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the "Chain of Survival." For adults they include When these links are implemented in an effective way, survival rates can approach 50% following witnessed out-ofhospital ventricular fibrillation (VF) arrest. 2 Unfortunately survival rates in many out-of-hospital and in-hospital settings fall far short of this figure. For example, survival rates following cardiac arrest due to VF vary from approximately 5% to 50% in both out-of-hospital and in-hospital settings. 3,4 This variation in outcome underscores the opportunity for improvement in many settings.Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate (or send someone to activate) the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing (ie, only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. 5 Chest compressions are an especially critical component of CPR because perfusion during CPR

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Section: Open the Airway: Healthcare Providermentioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

697

495

View full text Add to dashboard Cite

show abstract

“…Manual in-line stabilization has been shown to reduce the range of motion occurring during tracheal intubation. [23][24][25] In contrast, other studies have shown that MILS may actually increase the range of motion of the cervical spine during direct laryngoscopy. 26 However, these studies used volunteers with an intact spine or cadaver models with surgically-induced spinal lesions.…”

Section: Discussionmentioning

confidence: 91%

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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“…The intention is to apply forces that are equal in magnitude and opposite in direction to those being generated by the laryngoscopist to keep the head and neck in the neutral position. Avoiding traction forces during the application of MILI may be particularly important when there is gross spinal instability [71,86,87]. MILI reduces total spinal movement during the process of laryngoscopy and tracheal intubation [83], although Lennarson and colleagues [71,72] were unable to demonstrate that it resulted in reductions in movement at the site of instability in cadaver models.…”

Section: Airway Management For Cervical Spine Surgerymentioning

confidence: 99%

Considerations for Airway Management for Cervical Spine Surgery in Adults

Crosby

2007

Anesthesiology Clinics

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Cervical spine movement during orotracheal intubation

Cited by 186 publications

References 12 publications

Part 5: Adult Basic Life Support

Part 5: Adult Basic Life Support

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

Considerations for Airway Management for Cervical Spine Surgery in Adults

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