Airway management for individuals with suspected or confirmed traumatic cervical spine injuries: A comprehensive review and analysis

Abstract

Introduction

Patients with known or suspected cervical spine injuries may require either elective intubation for surgery involving neck stabilization or emergency intubation for ventilatory support and airway protection. This comprehensive review summarizes the collective evidences on management of airway when cervical spine injuries are suspected or confirmed.

Methods

Using the patient/population, intervention, comparison, and outcomes (PICO) clinical question and inclusion criteria, a search of the literature was conducted to find articles in electronic databases such as Scopus, Medline, Cochrane, PubMed, Google Scholar, and others. For patients who require emergency or elective airway securing and have or may have cervical spine injuries, a thorough assessment of published studies was carried out.

Results

This comprehensive review comprised seventy three articles from which conclusions were drawn. A number of publications concurred that videolaryngoscopes could lower the rate of unsuccessful intubations, especially in patients who initially arrive with a challenging airway. Videolaryngoscopes may lessen airway/laryngeal damage and enhance the glottic view. Managing the airway of patients with cervical spine injuries requires a multidisciplinary approach, continuous monitoring, minimizing excessive neck extension, applying rapid sequence intubation technique, and manual inline stabilization. These are highlights found in several papers.

Conclusions

Video laryngoscopy is an excellent alternative to direct visualizations techniques, especially for patients who are anticipated to have less an optimal airway view. Awake fiberoptic intubation allows for neurological exam before and after intubation to ensure minimal damage to spinal cord. However, patient selection is key and requires high level of patient cooperation, provider experience, and availability of local anesthetics.