Int J Intern Emerg Med | Volume 1, Issue 1 | Review Article | Open Access
Tzu-Yao Hung1,2,3, Li-Wei Lin3,4,5, Yu-Hang Yeh2, Yung-Cheng Su6,7, Chieh-Hung Lin2 and Yang Ten-Fang1,8*
1Department of Biomedical Science and Technology, National Chiao Tung University, Taiwan
2Department of Emergency Medicine, Taipei City Hospital, Taiwan
3Crazyat LAB (Critical Airway Training Laboratory), Taiwan
4Department of Emergency Medicine, Shin Kong Memorial Wu Ho-Su Hospital, Taiwan
5Fu Jen Catholic University, Taiwan
6Tzu Chi University, Taiwan
7Department of Emergency, Dalin Tzu Chi Hospital, Taiwan
8Taipei Medical University, Taiwan
*Correspondance to: Yang Ten-Fang
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Objective: Cormack-Lehane (C-L) grade III is considered as difficult airway where only the epiglottis is visualized under direct laryngoscopy and has a poor intubation success rate.
Objective: The purpose of the study is to investigate whether the endotracheal tube holding position, shapes and bend angles of endotracheal tube, stylet-assisted lifting of epiglottis can improve the success rate of intubation.
Methods: Thirty-two participants (26 physicians, 2 residents, and 4 nurse practitioners, average working length 12.09 ± 5.38 years in the emergency department with more than 150 annual intubation events) were enrolled in this randomized, cross-over mannequin study to investigate straight-to-cuff shape with 35° and 50° bend angles, banana shape, with longitudinal distance at 28 cm and 26 cm, holding the endotracheal tube on the top or middle, and their effects on intubation duration, success rate, and subjective difficulty. Lifting or not lifting of the epiglottis with stylets during intubation was also compared to investigate a better strategy in the management of C-L grade III.
Results: Two subgroups that performed lifting of the epiglottis with stylets had the shortest duration of intubation (23.75 ± 14.24's and 20.72 ± 6.90's in bend angles of 35° and 50°, Hazard ration 1.54 and 1.85 with confidence interval of 1.01 to 2.34 and 1.23 to 2.78, respectively) and 100% success rate of intubation. In survival analysis, only lifting of the epiglottis was significant (p <0.0001, 95% CI 1.34 to 2.11). Conclusions: The use of epiglottis lift as an adjunctive technique can facilitate and improve the intubation success rate in difficult airway graded as C-L III under direct laryngoscopy without increased difficulty.
Difficult airways; Intubation technique; Stylet shapes; Lifting of epiglottis; Bend angles; Cormack-lehane grade
Hung T-Y, Lin L-W, Yeh Y-H, Su Y-C, Lin C-H, Ten-Fang Y. Evaluation of a Better Intubation Strategy When Only the Epiglottis is Visible: a Mannequin Study. Int J Intern Emerg Med. 2018;1(1):1008.