Department of Pediatric Emergency, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa 31096, Israel.
Am J Emerg Med. 2012 Nov;30(9):2005-10. doi: 10.1016/j.ajem.2012.01.010. Epub 2012 Mar 16.
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.
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.
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).
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.
在直接喉镜检查中，对于声门显露不佳的情况，可采用外部喉操纵（ELM）技术。但目前缺乏关于儿科人群中 ELM 研究的报道。本研究旨在探讨缺乏经验的插管者使用 ELM 是否能提高小儿插管的成功率。
我们进行了一项随机对照模拟研究，比较了使用 ELM（研究组）与标准插管（对照组）的插管成功率。研究对象为急救医学专业的学生。每位参与者在 3 个不同的小儿气道模型上独立进行 1 次插管尝试。如果已经获得超过 2 级的理想 Cormack-Lehane 声门显露（CLGV），研究组被指示使用 ELM 进行插管；对照组则被指示继续使用标准插管。主要观察指标为单次尝试插管成功率、插管前 CLGV 和插管时间。
研究组共纳入 13 名受试者，共进行了 39 次插管。其中 19 次插管时获得了超过 2 级的 CLGV，并使用了 ELM；对照组共纳入 14 名受试者，共进行了 42 次插管。其中 20 次插管时获得了超过 2 级的 CLGV。在使用 ELM 之前，CLGV 评分中位数为 3.5，使用后为 2.0。然而，两组的插管成功率（10/19 与 14/20，P=0.43）和插管时间（对照组 25.8 秒 vs 研究组 37.8 秒，P<0.007）均无显著差异。
在本项小儿模拟研究中，初学者使用 ELM 可改善声门显露，但延长了插管时间，且并未提高插管成功率。
