I N T R O D U C T I O N
The incidence of cervical spine injury is reported to be
from 1% to 4% in all major trauma victims and may be as
high as 34% in patients with severe injuries.1-5With orotracheal
intubation (OTI) becoming the preferred technique
for airway management in the trauma victim,
proper cervical spine precautions are therefore imperative
in preventing or worsening spinal cord injuries. Two
techniques for maintaining cervical spine precautions
exist. First, a rigid cervical collar, with or without towel
rolls and tape, is applied in most out-of-hospital systems
and often left in place during intubation. Alternately,
manual in-line stabilization can be used and has been
advocated to be safe during OTI. The amount of cervical
spine movement produced during OTI with each of these
techniques has not been fully elucidated.
Multiple different laryngoscope blades are available for
use during OTI. The Miller straight blade and the Macintosh
curved blade are the 2 most commonly used blades;
however, their relative safety with regard to an injured
cervical spine has not been defined. A new laryngoscope
blade, the Corazelli-London-McCoy (CLM) hinged blade,
may decrease the amount of force required to visualize the
vocal cords during OTI, especially in cases of difficult
anatomy (Figure 1). The optimal blade in preventing cervical
spine movement during OTI has not been determined.
We created a cadaver model of cervical spine injury to
compare the relative safety of 2 different immobilization
techniques and each of 3 laryngoscope blades during
OTI. A randomized crossover design was used, with outcome
measures defined as axial distraction, anteroposterior
(AP) displacement, and angular rotation.