• Katarzyna Karczewska, Lukasz Szarpak, Jacek Smereka, Marek Dabrowski, Jerzy Robert Ladny, Wojciech Wieczorek, Oliver Robak, Michael Frass, Sanchit Ahuja, and Kurt Ruetzler.
• Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 Str., 02-005, Warsaw, Poland. lukasz.szarpak@gmail.com.
• Anaesthesiol Intensive Ther. 2017 Jan 1; 49 (4): 274-282.

BackgroundImmobilization of the cervical spine is indicated in all patients with the potential risk of any cervical spine injury. Airway management in these patients is challenging and direct laryngoscopy is the standard of care. Videolaryngoscopes like the ET-View were introduced into clinical practice to provide better airway visualization and ease intubation. The ET-View is essentially a conventional endotracheal tube, but is equipped with a miniature camera on the tip. The ET-View has not been investigated in patients with immobilized cervical spine so far. The aim was to evaluate the performance of the VivaSight SL compared with Macintosh when performed in patients with immobilized cervical spine by unexperienced physicians.MethodsThis was prospective, randomized, cross-over manikin trial. 50 novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. Overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack&Lehane graduation were assessed.ResultsAll physicians were able to intubate the manikin in all scenarios using the ETView, whereas direct laryngoscopy failed in 16 % with immobilized cervical spine using the patriot cervical extraction collar. First intubation attempt success rate was higher and airway visualization was better in all three scenarios using the ET-View compared to direct laryngoscopy.ConclusionThe ET-View offered much better 62 airway visualization and provided higher overall and first intubation attempt success rates. Therefore, the ET-View is a valuable alternative in patients with difficult intubation due to immobilized cervical spine. Further clinical trials are indicated to confirm these findings.Trial Registrationclinicaltrials.gov Identifier: NCT02733536.

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