Striking the Balance: Cervical Collar Adjustments for Optimized Intubation, finds study

Recent study conducted a randomized controlled trial to compare cervical spine motion during videolaryngoscopic intubation in patients wearing a cervical collar. The research aimed to evaluate the difference in cervical spine motion between applying only the posterior piece and applying both the anterior and posterior pieces of the cervical collar during intubation. A total of 102 patients were divided into posterior-only and anterior-posterior groups, and cervical spine motion was measured at different segments. The results showed that the differences in mean cervical spine motion between the two groups were approximately 1.2°, 1.0°, and -0.3° at different cervical spine segments.

Intubation Performance Comparison

The study observed that applying only the posterior piece of the cervical collar led to shorter intubation times compared to using both pieces. Despite this difference in intubation times, no significant variations were found in other intubation performance measures or associated complications between the two groups. Interestingly, the study found that the absence of the anterior piece did not significantly impact the cervical spine motion during intubation, contrary to expectations that it could increase motion due to altered lifting forces.

Advantages of Videolaryngoscopy

Moreover, the research highlighted that videolaryngoscopy offers advantages over direct laryngoscopy in terms of intubation success rate, time, glottic view, and cervical spine motion reduction. The study emphasized the importance of using videolaryngoscopes, especially in patients with cervical spine instability, to minimize potential complications like spinal cord injury due to excessive neck extension during intubation. The paper also discussed the limitations of the study, such as not measuring lifting forces during intubation and the need for continuous fluoroscopy to capture the maximum spine motion. The findings suggest that the decision to remove the anterior piece of the cervical collar for videolaryngoscopic intubation should consider individual patient needs and potential benefits in challenging intubation conditions.

Conclusion of the Study

In conclusion, the study's results indicated that removing the anterior piece of the cervical collar did not significantly affect cervical spine motion during intubation but resulted in shorter intubation times. These findings provide valuable insights for clinicians when considering the removal of the anterior piece to address difficult intubation scenarios in patients wearing a cervical collar.

Key Points

- Conducted a randomized controlled trial comparing cervical spine motion during videolaryngoscopic intubation in patients wearing a cervical collar.

- Evaluated the difference in cervical spine motion between applying only the posterior piece and applying both anterior and posterior pieces of the cervical collar during intubation. - Found differences in mean cervical spine motion between the groups at approximately 1.2°, 1.0°, and -0.3° at different cervical spine segments.

- Applying only the posterior piece of the cervical collar led to shorter intubation times compared to using both pieces without significant variations in other intubation performance measures or complications.

- Highlighted that videolaryngoscopy offers advantages over direct laryngoscopy in terms of intubation success rate, time, glottic view, and reduction of cervical spine motion, especially important in patients with cervical spine instability.

- Results suggest that the decision to remove the anterior piece of the cervical collar for videolaryngoscopic intubation should be individualized based on patient needs and potential benefits in challenging intubation conditions.

Reference –

Woo-Young Jo et al. (2024). Cervical Spine Motion During Videolaryngoscopic Intubation Using A Macintosh-Style Blade With And Without The Anterior Piece Of A Cervical Collar: A Randomized Controlled Trial. *Canadian Journal Of Anaesthesia*, 72, 142 - 151. https://doi.org/10.1007/s12630-024-02849-4.