Investigation of Upper Airway Problems in Resuscitation: Studies of Pharyngeal X-Rays and Performance by Laymen.

Ruben HM, Elam JO, Ruben AM, Green DG Anesthesiology 1961 Pages 271-279 OF HISTORICAL INTEREST

This report summarizes trials of mouth-to-mouth and mouth-to-nose breathing by laypeople and reviews X-Ray studies of head position in relation to upper airway patency. From these interdependent investigations, difficulties in maintaining the more traditional jaw or chin-lift methods were identified, and the requirements in technique for a hyperextension maneuver evolved. X-Ray studies were conducted in 31 anaesthetized supine adults to compare the air clearance of the nasal, oral, pharyngeal and laryngeal passages in relation to position of the head, neck and jaw. Head tilt produced an average clearance of 16 mm (13-25 mm) between the tongue and posterior pharynx, chin lift a clearance of 15 mm (10-24 mm), and jaw lift a clearance of 17 mm (9-25 mm). All three techniques produced a satisfactory upper airway. The differences in clearance are not meaningful, but only the head tilt procedure was easily maintained by the rescuer and is recommended for both mouth-to-mouth and mouth-to-nose resuscitation by laypeople.