CHAPTER 12 LARYNGEAL VIEW IMPROVEMENT IN LARYNGOSCOPY

Laryngeal View During Laryngoscopy: A Randomized Trial Comparing Cricoid Pressure, Back-Upward-Rightward Pressure, and Bimanual Laryngoscopy

Levitan RM, Kinkle WC, Levin WJ, et al. Ann Emerg Med. 2006;47(6):548–555

BACKGROUND

Endotracheal intubation is a complex, dynamic process, and the ability to view the larynx significantly impacts success rates. Various forms of external manipulation of the neck soft tissues have been taught to optimize laryngeal view during direct laryngoscopy. At the time of this study, results from prior, small studies led to significant controversy about which method most improved, or worsened, laryngeal exposure during intubation.

OBJECTIVES

To determine whether cricoid pressure, backward-upward-rightward pressure (BURP), or bimanual laryngoscopy best optimize laryngeal view compared to no external neck manipulation during direct laryngoscopy.

METHODS

Randomized intervention during 2-day, emergency airway cadaver-based workshops at a single academic department of EM in the United States.

Participants

Convenience sample of 104 clinicians: 89 EM attendings, 6 non-EM attendings, 6 PGY3 or PGY4 EM residents, 2 paramedics, and 1 physician assistant.

Intervention

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