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KMID : 1100620180050010022
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Clinical and Experimental Emergency Medicine
2018 Volume.5 No. 1 p.22 ~ p.28
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Cervical collar makes difficult airway: a simulation study using the LEMON criteria
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Yuk Moon-Su
Yeo Woon-Hyung
Lee Kang-Eui
Ko Jung-In
Park Tae-Jin
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Abstract
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Objective: Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway.
Methods: This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application.
Results: The mean inter-incisor distance significantly decreased from 4.3 to 2.6 cm (P<0.001). Fifty-seven participants classified as I and II were newly classified as III and IV according to the modified Mallampati classification after cervical collar application (16% to 91%). The angles of neck extension significantly decreased from 44° to 22° after cervical collar application (P<0.001). Before cervical collar application, our simulations predicted that 14 of 76 participants (18%) would have a difficult airway, whereas after cervical collar application, 76 of 76 (100%) were predicted to have a difficult airway.
Conclusion: All values for the LEMON criteria (mouth opening, modified Mallampati classification, and neck extension) worsened significantly after cervical collar application. Additionally, a difficult airway was predicted in all participants after cervical collar application.
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KEYWORD
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Airway management, Difficult airway, Cervical collar, LEMON criteria
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