Airway management in cervical spinal cord injured patients: a survey of European emergency physiciansʼ clinical practice

Abstract

No European airway management guidelines are currently specific to patients with cervical spinal cord injury (CSCI). The objectives of this study were to determine the clinical practice of European emergency physicians and anaesthesiologists regarding airway management in patients with CSCI. A questionnaire survey was completed by the participants of the fourth European Congress on Emergency Medicine regarding the preferred intubation techniques and the relevant skills, as well as airway management manoeuvres that, in the physician's opinion, caused the least and the greatest cervical spine movement. A total of 115 questionnaires from physicians from 15 European countries were returned. The most preferred techniques for tracheal intubation in patients with CSCI were the use of direct laryngoscopy, awake nasal intubation with a fibreoptic bronchoscope, and the use of the intubating and standard laryngeal mask airway, in descending order. Not all emergency physicians were skilled in an alternative intubation technique to direct laryngoscopy, in contrast to the anaesthesiologists, who were all familiar with at least the standard laryngeal mask airway. More than half of the physicians considered that the fibreoptic bronchoscope provided the least cervical spine movement. However, most of the physicians who indicated the use of the fibreoptic bronchoscope as their preferred technique, were not skilled in its use. Furthermore, two-thirds of the respondents did not recognise that mask ventilation causes considerable cervical spine movement. Emergency physicians need better training in airway management to anticipate problems in patients with CSCI.