Manual In-Line Stabilization of the Cervical Spine Increases the Rate of Difficult Oro-Tracheal Intubation in Adults - A Randomized Controlled Trial

Abstract

Background: Patients with traumatic brain injury present with loss of consciousness and
suspected cervical fracture. The aim of this study was to determine the rate of difficult orotracheal intubation in surgical patients undergoing various procedures when manual in-line neck immobilization technique was applied.
Methods: This was a randomized prospective study at the Lagos University Teaching Hospital. A total of 100 patients were enrolled into the study and were allocated into 2 groups of either Manual In-Line Stabilization (MILS) or Early Morning Sniffing position (EMSP) techniques during intubation. Successful or unsuccessful intubations within 30secs, as well as time to successful intubation were the outcome measures.
Results: The mean ± SD intubation time for successful intubation was similar in both groups (MILS=17.9±7.7 seconds, EMSP=14.6±6.6 seconds (p=0.359)).There were more failed intubations in the MILS group (27%) and (2%) in the EMSP group (p=0.001). 
Conclusion: The study showed that patients who had MILS had more failed intubations than those that were intubated with the EMSP technique. With this level of failed intubations there is need for provision of difficult airway laryngoscopic adjuncts for patients with diagnosed cervical fracture and uncleared cervical injury who require orotracheal intubation.

Key Words: Manual inline stabilization, Cervical spine injury, Orotracheal intubation, Difficult intubation