Airway management in patients with suspected or confirmed cervical spine injury

Matthew D. Wiles; Helen A. Iliff; Katherine Brooks; Egidio J. Da Silva; Mike Donnellon; Adrian Gardner; Matthew Harris; Caroline Leech; Steve Mathieu; Paul Moor; Lara Prisco; Kate Rivett; Frances Tait; Kariem El-Boghdadly

doi:10.1111/anae.16290

Airway management in patients with suspected or confirmed cervical spine injury

Matthew D. Wiles^*
, Helen A. Iliff
, Katherine Brooks
, Egidio J. Da Silva
, Mike Donnellon
, Adrian Gardner
, Matthew Harris
, Caroline Leech
, Steve Mathieu
, Paul Moor
, Lara Prisco
, Kate Rivett
, Frances Tait
, Kariem El-Boghdadly

^*Corresponding author for this work

Centre for Human & Applied Physiological Sciences

Sheffield Teaching Hospitals NHS Foundation Trust
Biomedical Research Centre, Sheffield Hallam University
Children's Hospital for Wales
Barts and The London Queen Mary's School of Medicine and Dentistry
University Hospitals Birmingham NHS Foundation Trust
College of Operating Department Practitioners
University of Aston
University Hospitals Coventry & Warwickshire NHS Trust
University Hospitals Coventry and Warwickshire NHS Trust
Air Ambulance Service
Portsmouth NHS Trust
Army HQ
University Hospitals Plymouth NHS Trust
John Radcliffe Hospital Headington
University of Oxford
Difficult Airway Society
Northampton General Hospital

Research output: Contribution to journal › Article › peer-review

36 Citations (Scopus)

43 Downloads (Pure)

Abstract

Background

There are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting.

Methods

An expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012–June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury.

Results

We included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors.

Conclusions

It is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.

Original language	English
Pages (from-to)	856-868
Number of pages	13
Journal	Anaesthesia
Volume	79
Issue number	8
Early online date	3 May 2024
DOIs	https://doi.org/10.1111/anae.16290
Publication status	Published - 14 Jul 2024

Keywords

airway management
cervical spinal injury
intubation
spinal cord injury
trauma

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10.1111/anae.16290Licence: CC BY

Airway management in patients with suspected or confirmed cervical spine injury_Version of RecordFinal published version, 264 KBLicence: CC BY

Cite this

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title = "Airway management in patients with suspected or confirmed cervical spine injury",

abstract = "BackgroundThere are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting. MethodsAn expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012–June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury. ResultsWe included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors. ConclusionsIt is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.",

keywords = "airway management, cervical spinal injury, intubation, spinal cord injury, trauma",

author = "Wiles, \{Matthew D.\} and Iliff, \{Helen A.\} and Katherine Brooks and \{Da Silva\}, \{Egidio J.\} and Mike Donnellon and Adrian Gardner and Matthew Harris and Caroline Leech and Steve Mathieu and Paul Moor and Lara Prisco and Kate Rivett and Frances Tait and Kariem El-Boghdadly",

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AU - Wiles, Matthew D.

AU - Iliff, Helen A.

AU - Brooks, Katherine

AU - Da Silva, Egidio J.

AU - Donnellon, Mike

AU - Gardner, Adrian

AU - Harris, Matthew

AU - Leech, Caroline

AU - Mathieu, Steve

AU - Moor, Paul

AU - Prisco, Lara

AU - Rivett, Kate

AU - Tait, Frances

AU - El-Boghdadly, Kariem

PY - 2024/7/14

Y1 - 2024/7/14

N2 - BackgroundThere are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting. MethodsAn expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012–June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury. ResultsWe included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors. ConclusionsIt is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.

AB - BackgroundThere are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting. MethodsAn expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012–June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury. ResultsWe included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors. ConclusionsIt is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.

KW - airway management

KW - cervical spinal injury

KW - intubation

KW - spinal cord injury

KW - trauma

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JO - Anaesthesia

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ER -

Airway management in patients with suspected or confirmed cervical spine injury

Abstract

Keywords

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