The BURP Maneuver Assists Inexperienced Health Care Professionals to Visualize Patient’s Glottis and Increase the Success Rate in Performing Endotracheal Intubation

Abstract

Objective: Comparing the effectiveness of the BURP (backward, upward, rightward pressure) maneuver versus conventional external laryngeal manipulation (ELM) in improving glottic visuali-zation and intubation success rates among inexperienced healthcare professionals. Methods: This randomized, double-blind, crossover study was conducted at Siriraj Hospital among 56 patients (ASA I-II) undergoing general anesthesia. Participants were randomized to receive the BURP maneuver followed by the conventional ELM technique or vice versa. Laryngoscopies and intubations were performed by inexperienced healthcare professionals who were blinded to the external manipulation technique. The BURP maneuver was applied by a single trained anesthesiologist, and the conventional ELM technique by nurse anesthetists who had not been trained in the BURP method. The primary outcome was laryngeal view (LV) grade change; the secondary outcome was intubation success. Patients with a grade 1 LV were excluded from paired analysis. Data were analyzed using paired t-tests and Wilcoxon signed-rank tests. Results: The BURP maneuver significantly improved glottic visualization compared to the conventional technique (p < 0.001). No grade 3 or 4 LV was observed in the BURP group, while 6 cases were in the conventional group. Four patients who could not be intubated with the conventional technique were successfully intubated after applying BURP while all BURP patients were successfully intubated. Conclusion: BURP improves glottic visualization and increase the first-pass intubation success rate in novice intubators. Incorporating BURP into airway management training may improve safety and outcomes.