The intubating laryngeal mask airway does not facilitate tracheal intubation in the presence of a neck collar in simulated trauma

Tracheal intubation must be performed with great care in the multiply injur ed patient when it must be assumed that the cervical spine may be damaged. Use of conventional direct laryngoscopy usually requires removal of the nec k collar and manual in-line stabilization of the head and neck. The intubat ing laryngeal mask (ILMA) has been designed to facilitate tracheal intubati on in the neutral position. We used the ILMA to intubate the trachea in 10 patients wearing a neck collar and with cricoid pressure applied in a simul ated trauma scenario. The ILMA was difficult to insert and ventilation prov ed difficult. In only two patients was intubation successful. These problem s were probably caused by the neck collar strap under the chin lifting up a nd tipping the larynx anteriorly. On the basis of these findings, ILMA use in a subject wearing a neck collar cannot be recommended.