In a patient with an unstable cervical spine injury requiring emergency intubation, in-line manual cervical stabilisation (MILS) is applied by an assistant. Compared with intubation without MILS, this manoeuvre is known to:

• A Significantly reduce the risk of secondary spinal cord injury during intubation
• B Be contraindicated because it increases intubation time and worsens hypoxia risk
• C Reduce cervical spine movement to zero, making direct laryngoscopy completely safe
• D Worsen the laryngoscopic view without proven reduction in neurological outcome ✓

Explanation

In-line stabilisation predictably worsens the laryngoscopic view by preventing the head extension that aligns the oral-pharyngeal-tracheal axes. However, evidence that MILS reduces neurological injury from intubation is lacking; no large trial shows improved neurological outcomes with MILS over careful direct or video laryngoscopy without MILS. Moreover, MILS does not eliminate cervical spine movement — cervical segment movement occurs at multiple levels and cannot be fully controlled by manual stabilisation alone. Videolaryngoscopy is advocated in this setting because it achieves a satisfactory view without requiring head extension.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.