title: Bimanual laryngoscopy: a videographic study of external laryngeal manipulation by novice intubators.
abstract: OBJECTIVE
  We perform a videographic analysis of external laryngeal manipulation (ELM) by novice intubators using a direct laryngoscopic imaging system and a validated means of assessing laryngeal view (percentage of glottic opening [POGO] score).
  
  
  METHODS
  Nine first-year emergency medicine residents performed a total of 484 laryngoscopies during a 1-year study period, of which 271 were videotaped. Of this convenience sample, cases were included in the study if the initial laryngeal view had a POGO score of less than 50% and the quality of video imaging permitted POGO scoring before and after application of ELM.
  
  
  RESULTS
  Seventy-two cases met the study criteria. Initial POGO scores equaled 0% in 30 cases, less than 20% in 20 cases, and 20% to 50% in 22 cases. ELM improved the POGO scores in all cases (95% confidence interval [CI] 96% to 100%) by an average of 57% (SD 23.7; 95% CI 40% to 75%). Among those with an initial POGO score equal to 0%, the mean improvement was 61% (SD 36.3; 95% CI 48% to 74%). For those with an initial POGO score of less than 20%, the mean improvement was 63% (SD 19.5; 95% CI 54% to 71%), and for those with an initial POGO score of 20% to 50%, the mean improvement was 47% (SD 16.0; 95% CI 40% to 55%).
  
  
  CONCLUSIONS
  ELM is a simple and very effective technique for improving laryngeal view during laryngoscopy by novice intubators.
authors.affiliation: Departments of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. levitanr@mail.upenn.edu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Levitan
authors.forename: Thomas
authors.initials: T
authors.lastname: Mickler
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
mesh_terms: D002983:Clinical Competence; D004635:Emergency Medicine / Q000193:education; D005931:Glottis / Q000033:anatomy & histology; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000502:physiology*; D020535:Video-Assisted Surgery / Q000379:methods*