Efficacy of the Kiwi‐grip technique for bougie‐assisted videolaryngoscopic endotracheal intubation in simulated cervical spine injury: A randomised manikin trial
Ho Pak CheukAbstract
Introduction
We compared the Kiwi‐grip technique with the traditional pencil grip technique for bougie‐assisted videolaryngoscopic endotracheal intubation in terms of intubation time on a manikin model with normal and simulated cervical spine injury airways.
Methods
In this prospective randomised crossover manikin trial, emergency department doctors performed videolaryngoscopic intubation using both the Kiwi‐grip and traditional pencil grip techniques. Each participant completed scenarios with a normal airway and a simulated cervical spine injury. Participants were randomly assigned to the order of techniques. Following standardised demonstration and familiarisation, intubation time, success rate and dental injury in each scenario were recorded. Upon completion of all scenarios, participants rated the two techniques using a questionnaire.
Results
Thirty‐six participants completed the study. In the normal airway scenario, mean intubation time was significantly shorter with the Kiwi‐grip technique (25.14 ± 7.23 s) compared with the traditional pencil grip (30.64 ± 8.55 s; p < 0.001). In the cervical spine injury scenario, mean intubation time was also significantly shorter with Kiwi‐grip (22.94 ± 4.66 s) versus traditional pencil grip (28.57 ± 8.75 s; p < 0.001). Dental injury rates were lower with Kiwi‐grip in both scenarios (normal: 22.2% vs. 36.1%; cervical: 47.2% vs. 58.3%). Twenty‐nine participants (80.6%) would recommend the Kiwi‐grip technique to colleagues, and 23 (63.9%) felt it improved their confidence in intubation.
Conclusion
In this manikin trial, the Kiwi‐grip technique, with the tube preloaded, was associated with a shorter intubation time than the traditional pencil grip in both a normal airway and a simulated cervical spine injury, but the effect of the grip cannot be isolated.