Excursions of the cervical spine during tracheal intubation: blind oral intubation compared with direct laryngoscopy

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Abstract
The most appropriate technique for performing tracheal intubation in patients with cervical spine injury is debatable. Recently, a new device enabling blind oral intubation (Augustine GuideTM) with the patient's head and neck in the neutral position has been introduced. The aim of this study was to compare the extent of upper cervical spine movement during intubation with this device compared to direct laryngoscopy. Twelve patients (Mallampati I and II), without a cervical spine injury, were intubated using the Augustine GuideTM and afterwards by direct laryngoscopy. Both procedures were viewed radiographically. Extension in the upper cervical spine was determined at the point of the maximum excursion. By evaluating the joints occiput‐C3 together as a functional unit, blind oral intubation caused 17° (median) less extension compared to direct laryngoscopy (p < 0.01). The median differences observed for the individual joints were: 7° in occiput‐C1 (p < 0.05), 5° in C1‐2 (p < 0.01) and 6° in C2‐3 (p < 0.01) respectively. Since we assume that intubation‐induced excursions of the injured spine are even higher, blind oral intubation might be a safe alternative for airway management in this special group of trauma victims.