title: External laryngeal manipulation does not improve the intubation success rate by novice intubators in a manikin study.
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.
authors.affiliation: Department of Pediatric Emergency, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa 31096, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Samuel
authors.forename: Karyn
authors.initials: K
authors.lastname: Winkler
authors.forename: Shuny
authors.initials: S
authors.lastname: Peled
authors.forename: Baruch
authors.initials: B
authors.lastname: Krauss
authors.forename: Itai
authors.initials: I
authors.lastname: Shavit
mesh_terms: D000328:Adult; D002648:Child; D004634:Emergency Medical Technicians / Q000193:education; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D007830:Larynx; D008297:Male; D008348:Manikins; D013997:Time Factors