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Air Med J. 2004 Jan-Feb;23(1):40-3.

Inverse intubation in air medical transport.

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Department of EMS/Trauma, LIFE STAR Helicopter Program, Hartford Hospital, Hartford, Connecticut 06102, USA.



The purpose of this study was to investigate the speed and accuracy of the inverse intubation procedure.


The operator crouches or kneels over the patient, straddling the torso. The laryngoscope is held in the operator's right hand in an overhand fashion, inserted gently into the patient's mouth, and pulled up and caudad. When the vocal cords are visualized, the endotracheal tube is passed with the left hand.


The procedure was taught to flight nurses and respiratory therapists (n = 21) using an intubating mannequin strapped to a stretcher in a BK 117 helicopter to simulate an in-flight intubation. The subjects were timed intubating the mannequin using both inverse and standard intubation techniques. Each technique was performed twice, and the times were averaged. The Wilcoxon Signed Ranks test was used to determine statistical significance.


No significant difference occurred between times of the standard (24.0 s) and inverse techniques (21.6 s) (P =.715) or number of attempts for successful endotracheal intubation (1.12 and 1.07, P =.581).


Inverse intubation is a useful skill for prehospital providers. This skill can be taught in a brief period and used successfully with no compromise in speed or success rate.

[Indexed for MEDLINE]

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