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A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway

  • Christopher Stein (a1), Louis Gerber (a1), Denis Curtin (a1), Nicole Oberem (a1) and Mike Wells (a1)...



The goal of this study was to compare the relative effectiveness of three adjunctive maneuvers – head elevation (HE), forward laryngoscope traction (FT), and external laryngeal manipulation (ELM) – on laryngoscopic view, intubation time, and intubation success performed by a sample of novice intubators using a simulated airway.


Twenty-two second year university paramedic students were required to perform laryngoscopy and intubation on a simulator four times on two separate days. The first day involved intubation using no adjunctive maneuvers (control) plus HE, FT, and ELM in random order in a normal simulated airway. A similar approach was used on the second day, but the simulator was configured to have a difficult airway. Percentage of glottic opening (POGO) scores, intubation time, and intubation success were measured for all intubation attempts.


Head elevation was found to be the most effective adjunctive maneuver in the normal airway, increasing the mean POGO score from control by 27% (P=.002), while ELM was most effective in the difficult airway, increasing the mean POGO score by 21% (P=.009) and the proportion of successful intubations by 41% (P<.001). All maneuvers decreased intubation time in the normal and difficult airway and were associated with significant differences in intubation success compared to control in the difficult airway.


This study identified HE as the most effective maneuver for improving laryngoscopic view in a normal airway and ELM as the most effective in a difficult airway in a group of novice intubators.

Stein C , Gerber L , Curtin D , Oberem N , Wells M . A Comparison of Three Maneuvers and Their Effect on Laryngoscopic View, Time to Intubate, and Intubation Outcome by Novice Intubators in a Simulated Airway. Prehosp Disaster Med. 2017;32(4):419423.


Corresponding author

Correspondence: Christopher Stein, PhD Department of Emergency Medical Care Faculty of Health Sciences University of Johannesburg P O Box 524, Auckland Park Johannesburg 2006 South Africa E-mail:


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Conflicts of interest: The authors declare no conflicts of interest.



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