Behari Dinell, Jaga Rudhir, Bergh Kobus, Hofmeyr Ross
Department of Anaesthesia & Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
Afr J Emerg Med. 2022 Dec;12(4):327-332. doi: 10.1016/j.afjem.2022.06.009. Epub 2022 Jul 26.
The Lubo collar is a cervical motion restriction device featuring a unique external jaw-thrust mechanism designed to provide non-invasive airway patency. In addition, tracheal intubation is facilitated by releasing an anterior chin strap; this allows better mouth opening than the previous generation of semi-rigid cervical collars. This study aimed to compare tracheal intubation using the Lubo collar combined with manual in-line stabilization (MILS) to intubation with MILS alone. The primary outcome was the time to successful intubation. Secondary outcomes compared intubation success rate, Cormack-Lehane grade, ease of intubation and dental trauma.
A randomized, cross-over, equivalence study was performed. Eighty full-time physician anaesthesia providers were recruited. Participants performed tracheal intubation using direct laryngoscopy on a manikin under two different scenarios: with the Lubo collar and MILS applied, and with MILS and no cervical collar. The time to successful intubation was measured and compared using two-one-sided and paired t-tests.
Intubation times fell well within the equivalence limits of 10 seconds, with a mean difference (95% CI) of 0.52 seconds (-1.30 to 2.56). There was no significant difference in intubation time with the Lubo collar (mean [SD] 19.2 [4.5] seconds) compared to the MILS alone group (19.7 [5.2] seconds). The overall success rate was 98.7% in the Lubo group and 100% in the MILS group. Adequate laryngoscopy views (Cormack-Lehane grades I to IIb) were equivalent between groups (Lubo 92.5% versus MILS alone 93.7%).
In this manikin-based study, the time to intubation with the Lubo collar and MILS applied was equivalent to time to intubation with MILS alone, with similar intubating conditions. Thus, the Lubo collar and MILS may simplify airway management by reducing the number of steps required to perform intubation in patients requiring cervical motion restriction.
Lubo颈托是一种颈椎活动限制装置，具有独特的外部颌部前推机制，旨在实现无创气道通畅。此外，松开前下巴系带便于气管插管；与上一代半刚性颈托相比，这能实现更好的张口效果。本研究旨在比较使用Lubo颈托联合手动直线稳定法（MILS）进行气管插管与单独使用MILS进行气管插管的情况。主要结局指标为成功插管时间。次要结局指标比较了插管成功率、Cormack-Lehane分级、插管难易程度及牙齿损伤情况。
进行了一项随机、交叉、等效性研究。招募了80名全职医生麻醉提供者。参与者在两种不同场景下对人体模型进行直接喉镜气管插管操作：应用Lubo颈托和MILS，以及仅应用MILS且不使用颈托。测量成功插管时间，并使用双侧单侧检验和配对t检验进行比较。
插管时间完全落在10秒的等效范围内，平均差值（95%CI）为0.52秒（-1.30至2.56）。与单独使用MILS组（19.7[5.2]秒）相比，使用Lubo颈托时的插管时间（平均[标准差]19.2[4.5]秒）无显著差异。Lubo组的总体成功率为98.7%，MILS组为100%。两组间充分的喉镜视野（Cormack-Lehane分级I至IIb）相当（Lubo组为92.5%，单独使用MILS组为93.7%）。
在这项基于人体模型的研究中，应用Lubo颈托和MILS时的插管时间与单独使用MILS时的插管时间相当，插管条件相似。因此，Lubo颈托和MILS可能通过减少对需要颈椎活动限制患者进行插管所需的步骤数量来简化气道管理。
