title: A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway.
abstract: Aim The goal of this study was to compare the relative effectiveness of three adjunctive maneuvers - head elevation (HE), forward laryngoscope traction (FT), and external laryngeal manipulation (ELM) - on laryngoscopic view, intubation time, and intubation success performed by a sample of novice intubators using a simulated airway.
  
  
  METHODS
  Twenty-two second year university paramedic students were required to perform laryngoscopy and intubation on a simulator four times on two separate days. The first day involved intubation using no adjunctive maneuvers (control) plus HE, FT, and ELM in random order in a normal simulated airway. A similar approach was used on the second day, but the simulator was configured to have a difficult airway. Percentage of glottic opening (POGO) scores, intubation time, and intubation success were measured for all intubation attempts.
  
  
  RESULTS
  Head elevation was found to be the most effective adjunctive maneuver in the normal airway, increasing the mean POGO score from control by 27% (P=.002), while ELM was most effective in the difficult airway, increasing the mean POGO score by 21% (P=.009) and the proportion of successful intubations by 41% (P<.001). All maneuvers decreased intubation time in the normal and difficult airway and were associated with significant differences in intubation success compared to control in the difficult airway.
  
  
  CONCLUSIONS
  This study identified HE as the most effective maneuver for improving laryngoscopic view in a normal airway and ELM as the most effective in a difficult airway in a group of novice intubators. Stein C , Gerber L , Curtin D , Oberem N , Wells M . A comparison of three maneuvers and their effect on laryngoscopic view, time to intubate, and intubation outcome by novice intubators in a simulated airway. Prehosp Disaster Med. 2017;32(4):419-423.
authors.affiliation: Department of Emergency Medical Care, Faculty of Health Sciences,University of Johannesburg,Johannesburg,South Africa.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stein
authors.affiliation: Department of Emergency Medical Care, Faculty of Health Sciences,University of Johannesburg,Johannesburg,South Africa.
authors.forename: Louis
authors.initials: L
authors.lastname: Gerber
authors.affiliation: Department of Emergency Medical Care, Faculty of Health Sciences,University of Johannesburg,Johannesburg,South Africa.
authors.forename: Denis
authors.initials: D
authors.lastname: Curtin
authors.affiliation: Department of Emergency Medical Care, Faculty of Health Sciences,University of Johannesburg,Johannesburg,South Africa.
authors.forename: Nicole
authors.initials: N
authors.lastname: Oberem
authors.affiliation: Department of Emergency Medical Care, Faculty of Health Sciences,University of Johannesburg,Johannesburg,South Africa.
authors.forename: Mike
authors.initials: M
authors.lastname: Wells
mesh_terms: D000488:Allied Health Personnel; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy / Q000193:education / Q000379:methods*; D008297:Male; D016544:Patient Simulation; D055815:Young Adult
keywords:  ELM external laryngeal manipulation;  ETI endotracheal intubation;  FT forward traction;  HE head elevation;  POGO percentage of glottic opening; airway management; endotracheal intubation; laryngoscopy