Bullard laryngoscopy by naÏve operators in the cervical spine immobilized patient

To determine ease of Bullard laryngoscopy by naïve operators during cervical spine immobilization, 21 residents, naïve to the Bullard laryngoscope, were assigned to perform Bullard laryngoscopy and standard direct laryngoscopy on the Laerdal SimMan Universal Patient Simulator while the rigid cervical spine function was engaged. Sequences were repeated. Success of laryngeal intubation, time to intubation, ease of intubation, and grade of laryngoscopic view were recorded and compared. Pairwise comparisons of consecutive times between standard and Bullard devices showed significant difference in mean times at first attempt, 28.8 (95% confidence interval [CI] 18.1-39.5) seconds in favor of Macintosh laryngoscopy, but no statistical differences between devices at second and third attempts, with differences in mean times of 4.5 (95% CI 2.5-6.5) and 3.8 (95% CI, 0.1-7.7) seconds, respectively. Similarly, ease of use was statistically unchanged over time for Macintosh laryngoscopy, but there was statistically significant improvement in ease of use for the Bullard. The Bullard laryngoscope is an easily mastered airway management device for intubation of the cervical spine immobilized patient.