Cervical collar makes difficult airway: a simulation study using the LEMON criteria.
- Author:
Moonsu YUK
1
;
Woonhyung YEO
;
Kangeui LEE
;
Jungin KO
;
Taejin PARK
Author Information
- Publication Type:Original Article
- Keywords: Airway management; Difficult airway; Cervical collar; LEMON criteria
- MeSH: Airway Management; Classification; Head; Healthy Volunteers; Humans; Intubation, Intratracheal; Mouth; Neck; Neck Injuries
- From: Clinical and Experimental Emergency Medicine 2018;5(1):22-28
- CountryRepublic of Korea
- Language:English
- Abstract: 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.
