Cervical vertebral movements during intubation with different pre-hospital advanced airway devices

Assessment of a trauma patient begins with cervical immobilization. These patients are assumed to have potential servical spine injury and any cervical spine movement during intubation process can lead to catastrophic results including paralysis, central respiratory failure and even death. Meanwhile, there are different intubation devices causing cervical vertebral column movement in different angles. And there is less known about pre-hospital advanced airway devices also known as supraglottic devices (laryngeal mask airway (LMA), intubating laryngeal mask airway (I-LMA), esophageal-tracheal combitube). Therefore we aimed to compare cervical spine movement with different advanced airway devices during intubation. Three fresh-frozen cadavers were used. Each cadaver was consecutively intubated by four doctors and with five different advanced airway devices (LMA, I-LMA, esophageal-tracheal combitube, Macintosh and McCoy laryngoscopes). We used cervical collar in our study. During each intubation process continuous cinefluoroscopic view was taken and then converted to photographic images to assess cervical spine movement. Maximal extension and flexion of C0 to C5 vertebral body angles were calculated and compared with each device. At C0C1 level, compared with the McCoy laryngoscope (median; 7°), LMA(median; 2,5°) and combitube (median; 1,5°) caused less extension of cervical vertebra. Also, combitube (median; -1°) and I-LMA (median; -2°) caused less extension of C2C3 cervical region when compared with the Macintosh laryngoscope (median; 3°). Except for these two results, there was no statistically significant difference between groups at C1C2, C3C4 and C4C5 levels. Supraglottic devices during airway management cause cervical vertebral movement less or equal to conventional laryngoscopes. And due to ease of training and blind insertion, supraglottic devices can be safely used in trauma patients when cervical spine integrity is a concern