Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-24T09:53:32.111Z Has data issue: false hasContentIssue false
  • English
  • Français

Airway Control in Trauma Patients with Cervical Spine Fractures

Published online by Cambridge University Press:  28 June 2012

S. Alan Lord ,
William C. Boswell ,
James S. Williams ,
John W. Odom  and
Carl R. Boyd
S. Alan Lord
Affiliation:
Department of Surgical Education, Memorial Medical Center, Savannah, Georgia
William C. Boswell
Affiliation:
Department of Surgical Education, Memorial Medical Center, Savannah, Georgia
James S. Williams*
Affiliation:
Department of Surgical Education, Memorial Medical Center, Savannah, Georgia
John W. Odom
Affiliation:
Department of Surgical Education, Memorial Medical Center, Savannah, Georgia
Carl R. Boyd
Affiliation:
Department of Surgical Education, Memorial Medical Center, Savannah, Georgia
*
Department of Surgical Education, Memorial Medical Center, P.O. Box 23089, Savannah, GA 31403-3089USA.
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Proper airway control in trauma patients who have sustained cervical spine fracture remains controversial.

Purpose:

This study was undertaken to survey the preferred methods of airway management in cervical spine fracture (CSF) patients, to evaluate the experience of handling such patients at a level-I trauma center, and to contrast the findings with recommendations of the American College of Surgeons Committee on Trauma.

Hypothesis:

The methods used for control of the airway in patients with fractures of their cervical spine support the recommendation of the American College of Surgeons (ACS) Committee on Trauma.

Methods:

The study consisted of two parts: 1) a survey; and 2) a retrospective study. Survey questionnaires were sent to 199 members of the Eastern Association for the Surgery of Trauma and to 161 anesthesiology training programs throughout the United States. Three resuscitation scenarios were posed: 1) Elective airway—CSF—breathing spontaneously, stable vital signs; 2) Urgent airway—CSF—breathing spontaneously, unstable vital signs; and 3) Emergent airway—CSF—apneic, unstable. In addition, a three-year retrospective study was conducted at a level-I trauma center to determine the method of airway control in patients with cervical spine fractures.

Results:

Responses to the questionnaires were received from 101 trauma surgeons (TS) and 58 anesthesiologists (ANESTH). Respondents indicated their preference of airway methods: Elective airway: Nasotracheal intubation: TS 69%, ANESTH 53%. Orotracheal intubation: TS and ANESTH 27%. Surgical airway: TS 4%. Intubation with fiberoptic bronchoscope (FOB): ANESTH 20%. Urgent airway: Nasotracheal intubation: TS 48%, ANESTH 38%. Orotracheal intubation: TS 47%, ANESTH 45%. Surgical airway: TS 4%. FOB: ANESTH 16%. Emergent airway: Orotracheal intubation: TS 81 %, ANESTH 78%. Surgical Airway: TS 19%, ANESTH 7%. FOB: ANESTH 15%.

The retrospective review at the trauma center indicated that 102 patients with CSF were admitted; 62 required intubation: four (6%) on the scene, seven (11%) en route, five (8%) in the emergency department, 42 (67%) in the operating room, and four (6%) on the general surgery floor. Airway control methods used were nasotracheal: 14 (22%); orotracheal: 27 (43%); FOB: 17 (27%); tracheostomy: one (2%); unknown: three (4%). No progression of the neurological status resulted from intubation.

Conclusion:

The choice of airway control in the trauma patient with CSF differs between anesthesiologists and surgeons. However, the method selected does not have an adverse affect on neurological status as long as in-line stabilization is maintained. The methods available are safe, effective, and acceptable. The recommendations of the American College of Surgeons Committee on Trauma for airway control with suspected cervical spine injury are useful. The technique utilized is dependent upon the judgment and experience of the intubator.

Keywords

airway obstructioncervical vertebrae fracturesdyspnea apneaemergency medical techniciansintratrachealintubationmultiple trauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 1 , March 1994 , pp. 44 - 49
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Podolsky, S, Baraff, LJ, Simon, RR et al. : Efficacy of cervical spine immobilization methods. J Trauma 1983;23:461–465.CrossRefGoogle ScholarPubMed
2. American College of Surgeons Committee on Trauma: Advanced Trauma Life Support Course, Instructor Manual Chicago: American College of Surgeons, 1990.Google Scholar
3. Oyster, CK, Hanten, WP, Llorens, LA: Introduction to Research: A Guide for the Health Science Professional Philadelphia: J. B. Lippincott, 1987, pp 92–93.Google Scholar
4. Cadoux, CG, White, JD, Hedberg, MC: High-yield roentgenographic criteria for cervical spine injuries. Ann Emerg Med 1987;16:738–742.CrossRefGoogle ScholarPubMed
5. Jacobs, I.M, Schwartz, R: Prospective analysis of acute cervical spine injury: A methodology to predict injury. Ann Emerg Med 1986;15:44–49.CrossRefGoogle ScholarPubMed
6. Fischer, R: Cervical radiographic evaluation of alert patients following blunt trauma. Ann Emerg Med 1984; 13:905–907.CrossRefGoogle ScholarPubMed
7. Bachullis, B, Long, WB, Hynes, GD et al. : Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg 1987:153:473–477.CrossRefGoogle Scholar
8. Shaffer, MA, Doris, PE: Limitation of the cross table lateral view in detecting cervical spine injuries: A retrospective analysis. Ann Emerg Med 1981:10:508–513.CrossRefGoogle ScholarPubMed
9. Boger, D, Ralls, PW: New traction device for radiography of the lower cervical spine. Am J Roentgenol 1981:137:1202–1204.CrossRefGoogle ScholarPubMed
10. Streitwieser, DR, Knopp, R, Wales, LR et al. , Accuracy of standard radiographic views in detecting cervical spine fractures. Ann Emerg Med 1983;12:538–542.CrossRefGoogle ScholarPubMed
11. Turns, JE, Shaffer, MA, Doris, PE: The modified odontoid view: An alternative visualization of the atlantoaxial joint. J Emerg Med 1984:1:321–325.CrossRefGoogle ScholarPubMed
12. Hockberger, RS, Doris, PE: Spinal injury, in Rosen P, Baker, FJ, Braen, GR et al. , (eds): Emergency Medicine: Concepts and Clinical Practice. St. Louis: C.V. Mosby, 1983, pp 289–330.Google Scholar
13. Doris, PE, Wilson, RA: The next logical step in the emergency radiographic evaluation of cervical spine trauma: The five-view trauma series. J Emerg Med 1885;3:371–385.CrossRefGoogle Scholar
14. Freemyer, B, Knopp, R, Piche, J et al. : Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma. Ann Emerg Med 1989:18:818–821.CrossRefGoogle ScholarPubMed
15. Borock, EC, Gabram, SGA, Jacobs, LM et al. : A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. J Trauma 1991:31:1001–1005.CrossRefGoogle ScholarPubMed
16. O'Brien, DJ, Danzl, DF, Hooker, EA et al. : Prehospital blind nasotracheal intubation by paramedics. Ann Emerg Med 1989:18:612–617.CrossRefGoogle ScholarPubMed
17. O'Brien, DJ, Danzl, DF, Sowers, MB et al. : Airway management of aeromedically transported trauma patients. J Emerg Med 1988;6:49–54.CrossRefGoogle ScholarPubMed
18. Fassoulaki, A, Pamouktsoglou, P: Prolonged nasotracheal intubation and its association with inflammation of paranasal sinuses. Anesth Analg 1989;69:50–52.CrossRefGoogle ScholarPubMed
19. Holley, J, Jordan, R: Airway management in patients with unstable cervical spine fractures. Ann Emerg Med 1989; 18:1237–1239.CrossRefGoogle ScholarPubMed
20. Grande, CM, Barton, CR, Stene JK: Appropriate techniques for airway management of emergency patients with suspected spinal cord injury. Anesth Analg 1988;67:714–715. Letter.CrossRefGoogle ScholarPubMed
21. Dunham, MC, Britt, DL, Stone, JK: Emergency tracheal intubation in the blunt injured patient. Proceedings of the Eastern Association for the Surgery of Trauma, Longboat Key, Florida, 12 January 1988.Google Scholar
22. Aprahamian, C, Thompson, BM, Finger, WA et al. : Experimental cervical spine injury model: Evaluation of airway management and splinting techniques. Ann Emerg Med 1984; 13:584–587.CrossRefGoogle ScholarPubMed
23. Bivins, HG, Ford, S, Bezmalinovic, Z et al. , The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine. Ann Emerg Med 1988;17:25–29.CrossRefGoogle ScholarPubMed
24. Hauswald, M, Sklar, DP, Tandberg, D et al. : Cervical spine movement during airway management: Cinefluoroscopic appraisal in human cadavers. Am J Emerg Med 1991;9:535–538.CrossRefGoogle ScholarPubMed
25. Majernick, TG, Bieniek, R, Houston, JB et al. : Cervical spine movement during orotracheal intubation. Ann Emerg Med 1986;15:417–420.CrossRefGoogle ScholarPubMed
26. Roberts, DJ, Clinton, JE, Ruiz, E: Neuromuscular blockade for critical patients in the emergency department. Ann Emerg Med 1986;15:152–156.CrossRefGoogle ScholarPubMed
27. Barriot, P, Riou, B: Retrograde technique for tracheal intubation in trauma patients. Crit Care Med 1988;16:712–713.CrossRefGoogle ScholarPubMed
28. Doolan, LA, O'Brien, JF: Safe intubation in cervical spine injury. Anesthesia and Intensive. Care 1985;13:319–324.CrossRefGoogle ScholarPubMed
29. Ligier, B, Buchman, TG, Breslow, MJ et al. : The role of anesthetic induction agents and neuromuscular blockade in the endotracheal intubation of trauma victims. Surg Gynecol Obstet 1991;173:477–481.Google ScholarPubMed
30. Chekan, E, Weber, S: Intubation with or without neuromuscular blockade in trauma patients with cervical spine injury. Anesth Analg 1990;70:S54. Abstract.CrossRefGoogle Scholar
31. Redan, JA, Livingston, DH, Tortella, BJ et al. , The value of intubating and paralyzing the suspected head-injured patient in the emergency room. J Trauma 1989;29:1730. Abstract.Google Scholar
32. Talucci, RC, Shaikh, KA, Schwab, CW: Rapid sequence induction with oral endotracheal intubation—the multiply injured patient. Amer Surg 1988;54:185–187.Google Scholar