1. Difficult Airway Management for Trauma: New Laryngoscope EVO2 Takami Komatsu and Yutaka Iwama Critical Care Center Teikyo University Hospital Tokyo, Japan June 2006

2. Introduction Immobilization of the cervical spine is necessary in case of trauma or cervical spine injury. It is difficult to intubate with laryngoscopes when the patient wears cervical collar. It is very useful if there are safe and rapid airway management methods without removing cervical orthosis.

3. Video Laryngoscopes

4. Comparison EVO2Conventional Video Laryngoscopes Blade CurveSharpNormal Mouth Opening (Apertura) SmallNecessary Head Tilt BackLessNecessary SpecificationPrism LensOptic Fiber or CCD AntifogO2 BlowNecessary (CCD: Afterheat)

5. Purpose of Use It is very difficult to intubate with conventional video laryngoscopes when the patient wears cervical collar, since aperture and head tilt back are insufficient. Intubation is performable without any difficulty by employing EVO2 even though the patient is completely immobilized with cervical orthosis. Comparison was drawn between conventional video laryngoscopes and EVO2 under the conditions of intubation 6 patients immobilized with cervical collars.

6. How to Evaluate Intubations were performed to the patients immobilized with cervical collars by employing conventional Macintosh video laryngoscope Fine View and EVO2, respectively. All the cases were video recorded and the time spent for completion intubation were also clocked up.

7. Laryngeal Development

9. Conclusion Quick intubation were performable to 6 trauma patients by employing EVO2. The mean time required to complete 6 cases intubation is 24.6 sec (17 sec. – 35 sec.) Intubation were absolutely un-performable to all 6 cases by employing conventional Macintosh video laryngoscopes unless cervical collars are removed.

10. Discussion Tracheal intubation for the patients who has limitation of mouth opening and limitation of back tilt is easily performable by employing EVO2. Whether EVO2 is useful to trauma patients must be under further consideration. Anesthesiologists are required to participate in primary care for trauma as experts of airway management.