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Behari D, Jaga R, Bergh K, Hofmeyr R. Intubation during spinal motion restriction using the LuboTM cervical collar - a manikin simulation study. Afr J Emerg Med 2022; 12:327-332. [PMID: 35919101 PMCID: PMC9334326 DOI: 10.1016/j.afjem.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/12/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The LuboTM collar is a cervical motion restriction device featuring a unique external jaw-thrust mechanism designed to provide non-invasive airway patency. In addition, tracheal intubation is facilitated by releasing an anterior chin strap; this allows better mouth opening than the previous generation of semi-rigid cervical collars. This study aimed to compare tracheal intubation using the LuboTM collar combined with manual in-line stabilization (MILS) to intubation with MILS alone. The primary outcome was the time to successful intubation. Secondary outcomes compared intubation success rate, Cormack-Lehane grade, ease of intubation and dental trauma. Methods A randomized, cross-over, equivalence study was performed. Eighty full-time physician anaesthesia providers were recruited. Participants performed tracheal intubation using direct laryngoscopy on a manikin under two different scenarios: with the LuboTM collar and MILS applied, and with MILS and no cervical collar. The time to successful intubation was measured and compared using two-one-sided and paired t-tests. Results Intubation times fell well within the a priori equivalence limits of 10 seconds, with a mean difference (95% CI) of 0.52 seconds (-1.30 to 2.56). There was no significant difference in intubation time with the LuboTM collar (mean [SD] 19.2 [4.5] seconds) compared to the MILS alone group (19.7 [5.2] seconds). The overall success rate was 98.7% in the Lubo group and 100% in the MILS group. Adequate laryngoscopy views (Cormack-Lehane grades I to IIb) were equivalent between groups (Lubo 92.5% versus MILS alone 93.7%). Conclusion In this manikin-based study, the time to intubation with the LuboTM collar and MILS applied was equivalent to time to intubation with MILS alone, with similar intubating conditions. Thus, the LuboTM collar and MILS may simplify airway management by reducing the number of steps required to perform intubation in patients requiring cervical motion restriction.
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2
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Ding Z, Ren Y, Cao H, Li Y, Chen S, Miao J, Li J. An Innovative Prone Position Using a Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Fracture Surgeries. Front Surg 2022; 9:649421. [PMID: 35356505 PMCID: PMC8960061 DOI: 10.3389/fsurg.2022.649421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background An innovative prone cervical spine surgical position using a body-shape plaster bed with skull traction (BSPST) was compared with the traditional prone surgical position with horseshoe headrests. Methods A total of 47 patients, undergoing posterior cervical spine surgery for cervical spine fracture, were retrospectively classified into two groups, the BSPST group (n = 24) and the traditional group (n = 23), and underwent a posterior instrumented fusion with or without decompression. Multiple indicators were used to evaluate the advantages of the BSPST compared with the traditional position. Results All the operations went smoothly. The mean recovery rate was 56.30% in the BSPST group and 48.55% in the traditional group (p = 0.454), with no significant difference. The intraoperative blood loss (177.5 ml vs. 439.1 ml, p = 0.003) and the total incidence of complications (8.3 vs. 47.8%, p = 0.004) were significantly less in the BSPST group than in the traditional group. In addition, the BSPST position provided a greater comfort level for the operators and allowed convenient intraoperative radiography. Conclusions This is the first study to describe a combined body-shape plaster bed and skull traction as an innovative cervical spine-prone surgical position that is simple, safe, and stable, intraoperative traction direction adjustable, reproducible, and economical for posterior cervical spine fracture surgery, and potentially other cervical and upper dorsal spine surgeries in the prone position. Additionally, this position provides the surgeons with a comfortable surgical field and can be easily achieved in most orthopedic operation rooms.
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Affiliation(s)
- Zhiyu Ding
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yijun Ren
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongqing Cao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuezhan Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shijie Chen
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinglei Miao
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinsong Li
- Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jinsong Li
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A multicenter cohort study on the association between prehospital immobilization and functional outcome of patients following spinal injury in Asia. Sci Rep 2022; 12:3492. [PMID: 35241763 PMCID: PMC8894344 DOI: 10.1038/s41598-022-07481-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/18/2022] [Indexed: 12/12/2022] Open
Abstract
Prehospital spinal immobilization is a widely used procedure in the emergency medical service (EMS) system worldwide, while the incidence of patients with spinal injury (SI) is relatively low, and unnecessary prehospital spinal immobilization is associated with patient complications. This study aimed to determine the association between prehospital spine immobilization and favorable functional outcomes at hospital discharge among trauma patients with SI. We conducted a retrospective cohort study using the Pan-Asia Trauma Outcomes Study (PATOS) registry data from January 1, 2016, to November 30, 2018. A total of 759 patients with SI were enrolled from 43,752 trauma patients in the PATOS registry during the study period. The subjects had a median age of 58 years (Q1–Q3, 41–72), and 438 (57.7%) patients had prehospital spine immobilization. Overall, prehospital spinal immobilization was not associated with favorable functional outcomes at discharge in multivariable logistic regression (aOR 1.06; 95% CI 0.62–1.81, p = 0.826). However, in the subgroup of cervical SI, prehospital spinal immobilization was associated with favorable functional outcomes at discharge (aOR 3.14; 95% CI 1.04–9.50; p = 0.043). Therefore, we suggest that paramedics should be more careful when determining the presence of a cervical SI and should apply full spine immobilization if possible.
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Courson R, Ellis J, Herring SA, Boden BP, Henry G, Conway D, McNamara L, Neal TL, Putukian M, Sills AK, Walpert KP. Best Practices and Current Care Concepts in Prehospital Care of the Spine-Injured Athlete in American Tackle Football March 2-3, 2019; Atlanta, GA. J Athl Train 2020; 55:545-562. [PMID: 32579669 PMCID: PMC7319739 DOI: 10.4085/1062-6050-430-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Sport-related spine injury can be devastating and have long-lasting effects on athletes and their families. Providing evidence-based care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidence-based medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations.
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Affiliation(s)
| | - James Ellis
- University of South Carolina School of Medicine, Greenville
| | - Stanley A Herring
- Department of Rehabilitation Medicine and The Sports Institute, University of Washington, Seattle
| | - Barry P Boden
- The Orthopaedic Center, A Division of CAO, Rockville, MD
| | | | | | - Lance McNamara
- Barrow County Schools, Winder-Barrow High School, Winder, GA
| | | | - Margot Putukian
- University Health Services, Rugers Robert Wood Johnson Medical School, Princeton, NJ
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Chan WH, Cheng CP, Chiu YL, Hsu YC, Hu MH, Huang GS. Two head positions for orotracheal intubation with the trachway videolight intubating stylet with manual in-line stabilization: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e19645. [PMID: 32332608 PMCID: PMC7220508 DOI: 10.1097/md.0000000000019645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The Trachway Videolight Intubating Stylet is a video-assisted system with a rigid but malleable intubating stylet that facilitates endotracheal intubation. Minimizing cervical spine movement with manual in-line stabilization is essential for patients with cervical spine injuries such as multiple trauma. However, the intubation time of the Trachway Videolight Intubating Stylet and complications associated with intubation in patients with manual in-line stabilization in the neutral-head and head-lift positions remain unclear. METHODS Patients (20-80 years old) who were scheduled to undergo surgery that required general anesthesia with tracheal intubation were randomly allocated to either a neutral-head (n = 62) or a head-lift position (n = 62) group. Manual in-line stabilization was performed to limit cervical spine mobility. We aimed to evaluate orotracheal intubation time and success rate in these 2 positions with the Trachway Videolight Intubating Stylet. RESULTS Intubation was faster in the head-lift than in the neutral-head position (20 ± 10 and 25 ± 13 seconds, respectively, P = .000); intubation was equally successful in the 2 positions (96.8% vs 96.8%). Responses to intubation did not differ between positions (heart rate, P = .142; visual analog scale scores for throat soreness, P = .54). The only significant predictor of intubation time was the body mass index in the head-lift position group (P = .005). CONCLUSIONS Intubation using the Trachway Videolight Intubating Stylet with manual in-line stabilization is faster in the head-lift position, and therefore preferable. However, if the head-lift position is not suitable, the neutral-head position is a sensible alternative, with comparable intubation success rate, heart rate change, and postoperative throat soreness.
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Affiliation(s)
- Wei-Hung Chan
- Department of Anesthesiology, Tri-Service General Hospital
| | - Chiao-Pei Cheng
- Department of Anesthesiology, Tri-Service General Hospital
- Graduate Institute of Medical Sciences
| | - Yu-Lung Chiu
- Graduate Institute of Medical Sciences
- School of Public Health, National Defense Medical Center, Taipei
| | - Yung-Chi Hsu
- Department of Anesthesiology, Tri-Service General Hospital
| | - Mei-Hua Hu
- Division of Pediatric General Medicine, Chang Gung Memorial Hospital, LinKou Branch
- Graduate Institute of Clinical Medical Sciences, College of Medicine
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Go-Shine Huang
- Department of Anesthesiology, Tri-Service General Hospital
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Comparison of the Vacuum Mattress versus the Spine Board Alone for Immobilization of the Cervical Spine Injured Patient: A Biomechanical Cadaveric Study. Spine (Phila Pa 1976) 2017; 42:E1398-E1402. [PMID: 28591075 DOI: 10.1097/brs.0000000000002260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical cadaveric study. OBJECTIVE We sought to determine the amount of motion generated in an unstable cervical spine fracture with use of the vacuum mattress versus the spine board alone. Our hypothesis is that the vacuum mattress will better immobilize an unstable cervical fracture. SUMMARY OF BACKGROUND DATA Trauma patients in the United States are immobilized on a rigid spine board, whereas in many other places, vacuum mattresses are used with the proposed advantages of improved comfort and better immobilization of the spine. METHODS Unstable subaxial cervical injuries were surgically created in five fresh whole human cadavers. The amount of motion at the injured motion segment during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc.). The measurements recorded in this investigation included maximum displacements during application and removal of the device, while tilting to 90°, during a bed transfer, and a lift onto a gurney. Linear and angular displacements were compared using the Generalized Linear Model analysis of variance for repeated measures for each of the six dependent variables (three planes of angulations and three axes of displacement). RESULTS There was more motion in all six planes of motion during the application process with use of the spine board alone, and this was statistically significant for axial rotation (P = 0.011), axial distraction (P = 0.035), medial-lateral translation (P = 0.027), and anteroposterior translation (P = 0.026). During tilting, there was more motion with just the spine board, but this was only statistically significant for anteroposterior translation (P = 0.033). With lifting onto the gurney, there was more motion with the spine board in all planes with statistical significance, except lateral bending. During the removal process, there was more motion with the spine board alone, and this was statistically significant for axial rotation (P = 0.035), lateral bending (P = 0.044), and axial distraction (P = 0.023). CONCLUSION There was more motion when using a spine board alone during typical maneuvers performed during early management of the spine injured patient than the vacuum mattress. There may be benefit of use of the vacuum mattress versus the spine board alone in preventing motion at an unstable, subaxial cervical spine injury. LEVEL OF EVIDENCE 2.
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Kornhall DK, Jørgensen JJ, Brommeland T, Hyldmo PK, Asbjørnsen H, Dolven T, Hansen T, Jeppesen E. The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. Scand J Trauma Resusc Emerg Med 2017; 25:2. [PMID: 28057029 PMCID: PMC5217292 DOI: 10.1186/s13049-016-0345-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/12/2016] [Indexed: 11/10/2022] Open
Abstract
The traditional prehospital management of trauma victims with potential spinal injury has become increasingly questioned as authors and clinicians have raised concerns about over-triage and harm. In order to address these concerns, the Norwegian National Competence Service for Traumatology commissioned a faculty to provide a national guideline for pre-hospital spinal stabilisation. This work is based on a systematic review of available literature and a standardised consensus process. The faculty recommends a selective approach to spinal stabilisation as well as the implementation of triaging tools based on clinical findings. A strategy of minimal handling should be observed.
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Affiliation(s)
- Daniel K Kornhall
- East Anglian Air Ambulance, Cambridge, UK. .,Department of Acute Medicine, Nordland Central Hospital, Postboks 1480, 8092, Bodø, Norway. .,Swedish Air Ambulance, Mora, Sweden.
| | - Jørgen Joakim Jørgensen
- Department of Traumatology, Oslo University Hospital, Oslo, Norway.,Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Neurosurgical Department, Oslo University Hospital, Oslo, Norway
| | - Per Kristian Hyldmo
- Trauma Unit, Sørlandet Hospital, Kristiansand, Norway.,Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway
| | - Helge Asbjørnsen
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Helicopter Emergency Medical Services, Bergen, Norway
| | - Thomas Dolven
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Thomas Hansen
- Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway
| | - Elisabeth Jeppesen
- Norwegian National Advisory Unit on Trauma, Oslo University Hospital, Oslo, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway
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Jose A, Nagori SA, Agarwal B, Bhutia O, Roychoudhury A. Management of maxillofacial trauma in emergency: An update of challenges and controversies. J Emerg Trauma Shock 2016; 9:73-80. [PMID: 27162439 PMCID: PMC4843570 DOI: 10.4103/0974-2700.179456] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Trauma management has evolved significantly in the past few decades thereby reducing mortality in the golden hour. However, challenges remain, and one such area is maxillofacial injuries in a polytrauma patient. Severe injuries to the maxillofacial region can complicate the early management of a trauma patient owing to the regions proximity to the brain, cervical spine, and airway. The usual techniques of airway breathing and circulation (ABC) management are often modified or supplemented with other methods in case of maxillofacial injuries. Such modifications have their own challenges and pitfalls in an already difficult situation.
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Affiliation(s)
- Anson Jose
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shakil Ahmed Nagori
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Agarwal
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Innovative Apparatus for Quantitatively Evaluating Effectiveness of Cervical Orthosis and Cervical Thoracic Orthosis. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Prasarn ML, Horodyski M, DiPaola MJ, DiPaola CP, Del Rossi G, Conrad BP, Rechtine GR. Controlled Laboratory Comparison Study of Motion With Football Equipment in a Destabilized Cervical Spine: Three Spine-Board Transfer Techniques. Orthop J Sports Med 2015; 3:2325967115601853. [PMID: 26535397 PMCID: PMC4622296 DOI: 10.1177/2325967115601853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Numerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a spine board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a spine board. Purpose To test 3 different transfer maneuvers of an injured football player onto a spine board to determine which method most effectively minimizes spinal motion in an injured cervical spine model. Study Design Controlled laboratory study. Methods Five whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-boarding techniques evaluated were the log roll, the lift and slide, and the 8-person lift. Results The 8-person lift technique resulted in the least amount of angular and linear motion for all planes tested as compared with the lift-and-slide and log-roll techniques. This reached statistical significance for lateral bending (P = .031) and medial-lateral translation (P = .030) when compared with the log-roll maneuver. The lift-and-slide technique was significantly more effective at reducing motion than the log roll for axial rotation (P = .029) and lateral bending (P = .006). Conclusion The log roll resulted in the most motion at an unstable cervical injury as compared with the other 2 spine-boarding techniques examined. The 8-person lift and lift-and-slide techniques may both be more effective than the log roll at reducing unwanted cervical spine motion when spine boarding an injured football player. Reduction of such motion is critical in the prevention of iatrogenic injury.
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Affiliation(s)
- Mark L Prasarn
- Department of Orthopaedics, University of Texas, Houston, Texas, USA
| | - MaryBeth Horodyski
- Department of Orthopaedics, University of Florida, Gainesville, Florida, USA
| | - Matthew J DiPaola
- Department of Orthopaedics, Wright State University, Dayton VA Medical Center, Dayton, Ohio, USA
| | | | - Gianluca Del Rossi
- Department of Orthopaedics, University of South Florida, Tampa, Florida, USA
| | - Bryan P Conrad
- Department of Orthopaedics, University of Florida, Gainesville, Florida, USA
| | - Glenn R Rechtine
- Department of Orthopaedics, VA Medical Center, Asheville, North Carolina, USA
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Effectiveness of Adjustable Cervical Orthoses and Modular Cervical Thoracic Orthoses in Restricting Neck Motion: A Comparative In vivo Biomechanical Study. Spine (Phila Pa 1976) 2015; 40:E1046-51. [PMID: 26076435 DOI: 10.1097/brs.0000000000001013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vivo biomechanical study. OBJECTIVE To compare the effectiveness of adjustable cervical orthoses (COs) and modular cervical thoracic orthoses (CTOs) with standard devices in restricting neck motion in all 3 anatomical planes. SUMMARY OF BACKGROUND DATA No literature is available regarding the effectiveness of adjustable COs and modular CTOs in restricting neck motion, and existing in vivo evaluation methodologies lack consistency and objectivity. METHODS The effectiveness of adjustable COs (Vista collar and Vista multipost collar) and modular CTOs (Vista TS, Vista TS with multipost, and Vista TS4 with multipost) in comparison with standard devices (Aspen collar [AC] and Aspen cervical thoracic orthosis) in restricting neck motion across 3 anatomical planes was studied in vivo in 27 healthy participants across prescribed loading levels ranging from 0.5 to 2.0 N·m. Neck range of motion allowed was compared between devices using Tukey post hoc test. The compliance of devices in restricting flexion and extension was obtained via a linear regression model. RESULTS When compared with modular CTOs, Aspen CTO was significantly more effective at motion restriction in both sagittal and frontal planes under loading level higher than 1.5 N·m. Modular CTOs outperformed adjustable COs in most of the cases but were fairly comparable with the standard CO (i.e., AC). Adjustable COs were just as effective as standard COs. The compliances of devices in restricting neck flexion ranked in ascending order were 0.83 (Aspen CTO), 1.53 (Vista TS with multipost), 1.60 (Vista TS4 with multipost), 1.77 (Vista multipost collar), 1.78 (AC), 1.99 (Vista TS), and 2.43 (Vista Collar) degrees per N·m. CONCLUSION Overall, modular CTOs had poorer performance in neck restriction than their standard counterpart (ACTO), whereas adjustable COs showed overall comparable performance to their standard counterpart (AC). The outcomes may assist clinicians in selecting appropriate devices. LEVEL OF EVIDENCE N/A.
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12
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Prasarn ML, Horodyski M, Behrend C, Del Rossi G, Dubose D, Rechtine GR. Is it safe to use a kinetic therapy bed for care of patients with cervical spine injuries? Injury 2015; 46:388-91. [PMID: 25457336 DOI: 10.1016/j.injury.2014.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/22/2014] [Accepted: 10/14/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bedrest is often used for temporary management, as well as definitive treatment, for many spinal injuries. Under such circumstances patients cannot remain flat for extended periods due to possible skin breakdown, blood clots, or pulmonary complications. Kinetic therapy beds are often used in the critical care setting, although this is felt to be unsafe for turning patients with spine fractures. We sought to evaluate whether a kinetic therapy bed would cause as much spinal motion at an unstable cervical injury as occurs during manual log-rolling on a standard intensive care unit bed. METHODS Unstable C5-C6 ligamentous injuries were surgically created in 15 fresh, whole cadavers. Sensors were affixed to C5 and C6 posteriorly and electromagnetic motion tracking analysis performed. In all cases a cervical collar was applied by an orthotist after creation of the injury. The amount of angular motion and linear displacement that occurred at this injured level was measured during manual log-rolling and patient turning using a kinetic therapy bed. For statistical analysis, the range of motion for angles about each axis and displacement in each direction was analyzed by multivariate analysis of variance with repeated measures. RESULTS When comparing manual log-rolling and kinetic bed therapy, significantly more angular motion was created by the log-roll manoeuvre in flexion-extension (p=0.03) and lateral bending (p=0.01). There was no significant difference in axial rotation between the two methods (p=0.80). There were no significant differences demonstrated in medial-lateral and anterior-posterior translation. There was almost two times the axial displacement between manual log-rolling and the kinetic therapy bed and this reached statistical significance (p=0.05). CONCLUSION There is less motion at an unstable cervical injury in flexion-extension, lateral bending, and axial displacement when turning a patient using a kinetic therapy bed as opposed to traditional manual log-rolling. It may be preferable to use a kinetic therapy bed rather than manual log-rolling for patients with cervical spine injuries to decrease unwanted spinal motion. In addition, it may be easier and less physically demanding on nursing staff that must regularly turn the patient if manual log-rolling is implemented.
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Affiliation(s)
- Mark L Prasarn
- Department of Orthopaedics and Rehabilitation, University of Texas, Houston, TX, United States
| | - MaryBeth Horodyski
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, United States
| | - Caleb Behrend
- Department Of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, United States
| | - Gianlucca Del Rossi
- Department of Orthopaedics and Rehabilitation, University of South Florida, Tampa, FL, United States
| | - Dewayne Dubose
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, United States
| | - Glenn R Rechtine
- Department Of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY, United States; Bay Pines Veterans Affairs Hospital, Clearwater, FL, United States
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13
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Abstract
To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury.
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Affiliation(s)
- Naola Austin
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Arman Dagal
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma 2014; 31:531-40. [PMID: 23962031 PMCID: PMC3949434 DOI: 10.1089/neu.2013.3094] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.
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Affiliation(s)
- Terje Sundstrøm
- 1 Department of Biomedicine, University of Bergen , Bergen, Norway
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