视频喉镜用于气管插管：关于不使用颈托进行手动轴向稳定与完全固定的考量
Video Laryngoscopy for Endotracheal Intubation: A Consideration for Manual In-Line Stabilization Without Cervical Collar Versus Full Immobilization.
作者信息
Aramvanitch Kasamon, Leela-Amornsin Sittichok, Tienpratarn Welawat, Nuanprom Promphet, Aussavanodom Supassorn, Yuksen Chaiyaporn, Boonsri Sirinapa, Boonjarus Natcha, Sanepim Somchoak
机构信息
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
出版信息
Ther Clin Risk Manag. 2025 Jan 25;21:103-109. doi: 10.2147/TCRM.S486978. eCollection 2025.
INTRODUCTION
Traumatic patients with cervical spine motion restriction have difficulty with endotracheal intubation (ETI) due to the limitations of neck movement and mouth opening. Nevertheless, the removal of the cervical collar for ETI in a prehospital setting may lead to a deterioration in neurological outcomes. This study compares the success rate of ETI utilizing a video laryngoscope (VL) on a manikin, contrasting manual in-line stabilization (MILS) without a cervical hard collar against full immobilization.
METHODS
A randomized, non-crossover study was conducted involving 56 paramedic students assigned by SNOSE to utilize various box sizes for VL intubation with MILS without a cervical hard collar or full immobilization technique on a manikin. The primary outcome was the intubation success rate. Secondary outcomes included attempts, time for successful intubation, and Cormack-Lehane classification.
RESULTS
Fifty-six participants were evaluated; 28 were in the full immobilization group, and another 28 were in the MILS without cervical hard collar group. Baseline characteristics showed no difference between both groups. The success rate of VL intubation showed no difference between the full immobilization group and the MILS without a cervical hard collar group (28 [100%] vs 28 [100%]; 24 [85.71%] vs 27 [96.43%] on first attempt; 4 [14.29%] vs 1 [3.57%] on second attempt; p-value 0.352). Time required to perform successful intubation (median [IQR] 17.20 [12.53, 24.40] vs 17.53 [14.06, 23.73], p-value 0.694) and Cormack-Lehane classification (11 [39.29%] vs 10 [35.71%] in grade I; 16 [57.14%] vs 17 [60.71%] in grade II; 1 [3.57%] vs 1 [3.57%] in grade III, p-value 1.000) showed no statistical difference between the two groups.
CONCLUSION
It is unnecessary to remove the cervical hard collar when performing endotracheal intubation while using a video laryngoscope.
引言
颈椎活动受限的创伤患者由于颈部活动和张口受限，气管插管（ETI）存在困难。然而，在院前环境中为进行气管插管而移除颈托可能会导致神经功能预后恶化。本研究比较了在人体模型上使用视频喉镜（VL）进行气管插管的成功率，对比了不使用颈椎硬颈托的手动直线稳定法（MILS）和完全固定法。
方法
进行了一项随机、非交叉研究，56名护理专业学生由SNOSE分配，在人体模型上使用不同尺寸的盒子进行VL插管，采用不使用颈椎硬颈托的MILS或完全固定技术。主要结局是插管成功率。次要结局包括尝试次数、成功插管时间和科马克-莱汉内分级。
结果
对56名参与者进行了评估；28名在完全固定组，另外28名在不使用颈椎硬颈托的MILS组。基线特征显示两组之间无差异。VL插管成功率在完全固定组和不使用颈椎硬颈托的MILS组之间无差异（28例[100%]对28例[100%]；首次尝试时24例[85.71%]对27例[96.43%]；第二次尝试时4例[14.29%]对1例[3.57%]；p值0.352）。成功插管所需时间（中位数[四分位间距]17.20[12.53，24.40]对17.53[14.06，23.73]，p值0.694）和科马克-莱汉内分级（I级11例[39.29%]对10例[35.71%]；II级16例[57.14%]对17例[60.71%]；III级1例[3.57%]对1例[3.57%]，p值1.000）在两组之间无统计学差异。
结论
使用视频喉镜进行气管插管时，无需移除颈椎硬颈托。
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