Airway management in patients with suspected or confirmed cervical spine injury

WILES, Matthew, ILIFF, Helen A., BROOKS, Katherine, DA SILVA, Egidio J., DONNELLON, Mike, GARDNER, Adrian, HARRIS, Matthew, LEECH, Caroline, MATHIEU, Steve, MOOR, Paul, PRISCO, Lara, RIVETT, Kate, TAIT, Frances and EL‐BOGHDADLY, Kariem (2024). Airway management in patients with suspected or confirmed cervical spine injury. Anaesthesia.

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Abstract

Summary: 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.

Item Type:	Article
Additional Information:	** Article version: VoR ** From Wiley via Jisc Publications Router ** Licence for VoR version of this article: http://creativecommons.org/licenses/by/4.0/ **Journal IDs: issn 0003-2409; issn 1365-2044 **Article IDs: publisher-id: anae16290; society-id: anae.2024.00082 **History: published_online 03-05-2024; accepted 16-03-2024
Uncontrolled Keywords:	cervical spinal injury, intubation, trauma, spinal cord injury, airway management
Identification Number:	https://doi.org/10.1111/anae.16290
SWORD Depositor:	Colin Knott
Depositing User:	Colin Knott
Date Deposited:	10 May 2024 10:03
Last Modified:	10 May 2024 10:15
URI:	https://shura.shu.ac.uk/id/eprint/33671

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