DAS: Airway management in patients with suspected or confirmed cervical spine injury

Question 1

Recommendations for pre-oxygenation and face mask ventilation in patients with a cervical spine injury

Answer 1

• Minimise cervical spine movement
• Jaw thrust rather than head-tilt chin lift
• Consider HFNO but caution if there is a risk of base of skull fracture

Question 2

Recommendations for supraglottic airway devices in patients with a cervical spine injury

Answer 2

• Should not be used to reduce neck movement
• Second-generation SADs should be used over first generations

Question 3

Recommendations for tracheal intubation (and adjuncts) in patients with a cervical spine injury

Answer 3

• Where possible use video laryngoscopy first line
• Clinicians should receive regular training in using VLs
• Consider the use of a stylet or bougie in patients whose neck is immobilised
• Cricoid should be removed if difficult intubation
• Do not use cricoid if laryngeal injury is suspected

Question 4

Recommendations for cervical spine immobilisation during intubation in patients with a cervical spine injury

Answer 4

• MILS worsens glottic view and has low evidence it reduces the risk of secondary injury if using then low threshold for removal if difficult intubation
• Rigid collars should be removed prior to intubation