Airway management in patients with suspected or conﬁrmed traumatic spinal cord injury: a narrative review of current evidence

Anaesthesia, 2022 · DOI: 10.1111/anae.15807 · Published: October 1, 2022

Spinal Cord Injury Anesthesiology Trauma

Simple Explanation

This review examines the best ways to manage the airway in patients with potential spinal cord injuries, focusing on techniques to minimize further damage during procedures like intubation. The review suggests that while all airway interventions cause some spinal movement, the actual risk of causing further spinal cord injury during intubation is likely minimal. Ultimately, the choice of intubation technique should depend on the clinician's proficiency and what is most likely to minimize cervical spine movement in each unique situation.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
Manual in-line stabilization (MILS) may worsen the laryngeal view during direct laryngoscopy, increasing the risk of failed intubation.
2
There's no strong evidence that awake tracheal intubation prevents secondary spinal cord injury, and videolaryngoscopy appears to be a suitable alternative to flexible bronchoscope-guided intubation.
3
Direct laryngoscopy causes slightly more cervical spine movement than videolaryngoscopy, but this does not clearly increase the risk of spinal cord compression.

Research Summary

This review addresses airway management in patients with suspected or confirmed traumatic spinal cord injury, aiming to guide best clinical practice. MILS is shown to potentially worsen laryngeal view and increase the risk of failed intubation, while awake tracheal intubation lacks clear evidence of benefit in preventing secondary spinal cord injury. The review concludes that the choice of intubation technique should depend on the clinician's proficiency and the specific clinical setting, emphasizing the need for further research focusing on clinically important outcome measures.

Practical Implications

Technique Selection

Clinicians should prioritize the intubation technique they are most proficient with to minimize cervical spine movement, considering the individual patient and clinical context.

Re-evaluate MILS Usage

The continued routine use of MILS should be questioned due to its potential to worsen laryngeal view and increase the risk of failed intubation, without clear evidence of spinal stabilization.

Future Research

Future studies should focus on clinically important outcome measures like space available for cord (SAC) and utilize newer videolaryngoscopes to refine airway management strategies in this patient population.

Study Limitations

1
Most research is based on healthy volunteers or cadavers with surgically created injuries, limiting generalizability.
2
Many studies use surrogate measurements of bony cervical spine movement, which may not accurately reflect changes in cervical spinal canal diameter.
3
There is a lack of long-term follow-up in most patient studies, precluding determination of late neurological deterioration following tracheal intubation.

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