Cervical collar effect on pulmonary volumes in patients with trauma

Ala, Alireza; Vahdati, Samad Shams; Taghizadieh, Ali; Miri, Seyed Hassan; Kazemi, N.; Hodjati, S. R.; Jalilzadeh-Binazar, Mehran

doi:10.1007/s00068-015-0565-1

Cited by 18 publications

(10 citation statements)

References 7 publications

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“…In line with previous publications, additional publications proposing possible harmful effects were found. For example, longer stay in the emergency room [43], decreased lung function [44], development of pressure ulcers [13, 45], impeded airway management [22], worsening of existing cervical injury [22], severe neurological deterioration in patients with ankylosing spondylitis [22], triggering of non-compliance or agitation and even increased spinal movement due to pain or discomfort [22] as well as possible elevation of intracranial pressure [46].…”

Section: Resultsmentioning

confidence: 99%

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Maschmann

Jeppesen

Rubin

et al. 2019

Scand J Trauma Resusc Emerg Med

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Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. However, the procedure has been questioned in recent years, due to the lack of high-quality studies supporting its efficacy. A national interdisciplinary task force was therefore established to provide updated clinical guidelines on prehospital procedures for spinal stabilisation of adult trauma patients in Denmark. The guidelines are based on a systematic review of the literature and grading of the evidence, in addition to a standardised consensus process. This process yielded five main recommendations: A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice. Electronic supplementary material The online version of this article (10.1186/s13049-019-0655-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Maschmann

Jeppesen

Rubin

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…These results are supported by other studies analyzing the effects of cervical collars. 37,38 Because many complications seem to accompany the use of a cervical collar, 4,[36][37][38] it remains questionable if the general application of a cervical collar in almost every trauma patient represents best practice.…”

Section: Discussionmentioning

confidence: 99%

Remaining Cervical Spine Movement Under Different Immobilization Techniques

Uzun

Jung

Weerts

et al. 2020

Prehosp. Disaster med.

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Background:Immobilization of the cervical spine by Emergency Medical Services (EMS) personnel is a standard procedure. In most EMS, multiple immobilization tools are available.The aim of this study is the analysis of residual spine motion under different types of cervical spine immobilization.Methods:In this explorative biomechanical study, different immobilization techniques were performed on three healthy subjects. The test subjects’ heads were then passively moved to cause standardized spinal motion. The primary endpoints were the remaining range of motion for flexion, extension, bending, and rotation measured with a wireless human motion detector.Results:In the case of immobilization of the test person (TP) on a straight (0°) vacuum mattress, the remaining rotation of the cervical spine could be reduced from 7° to 3° by additional headblocks. Also, the remaining flexion and extension were reduced from 14° to 3° and from 15° to 6°, respectively. The subjects’ immobilization was best on a spine board using a headlock system and the Spider Strap belt system (MIH-Medical; Georgsmarienhütte, Germany). However, the remaining cervical spine extension increased from 1° to 9° if a Speedclip belt system was used (Laerdal; Stavanger, Norway). The additional use of a cervical collar was not advantageous in reducing cervical spine movement with a spine board or vacuum mattress.Conclusions:The remaining movement of the cervical spine is minimal when the patient is immobilized on a spine board with a headlock system and a Spider Strap harness system or on a vacuum mattress with additional headblocks. The remaining movement of the cervical spine could not be reduced by the additional use of a cervical collar.

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“…Furthermore, one study found that application of a cervical collar causes a significant decrease in lung capacity and spirometry parameters, [3] but they did not examine the consequences hereof, such as whether this caused a subjective experience of dyspnoea.…”

Section: Discussionmentioning

confidence: 99%

“…Many researchers have, however, raised concerns about immobilisation and questioned its efficacy, the risk of over-triage and potential harmful effects as the evidence of the benefits of spinal immobilisation has been limited [1, 2]. Furthermore, several studies have identified complications related to immobilisation, such as tissue ischemia, pressure ulcers and decreased lung volumes [3–5]. These complications have, however, been measured objectively without accounting for the subjective experience secondary thereto, such as possible pressure, discomfort and dyspnoea related to being immobilised.…”

Section: Introductionmentioning

confidence: 99%

Patient experience of spinal immobilisation after trauma

Ottosen

Steinmetz

Larsen

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background Spinal immobilisation of blunt trauma victims with potential spinal cord injury is considered standard of care. The traditional management has, however, been increasingly questioned and concerns about harm have been raised. Few studies have described the perspective of the trauma patient regarding the spinal immobilisation. The objective of this study was therefore to evaluate the patient experience of immobilisation after trauma. Methods We prospectively screened adult trauma patients admitted to a level 1 trauma centre for eligibility. We included adult trauma patients who had been, and remembered being, immobilised for spinal protection with a cervical collar and a spine board prehospitally or upon arrival at the trauma centre. A semi-structured interview was conducted 2 to 72 h after admission either in person or by telephone. Results One hundred and fourteen patients were eligible for inclusion based on the patient charts. Out of 98 patients assessed for participation, 48 (49%) had no memory of being immobilised. We thus included 50 patients with a median age of 37 years (IQR: 26–60) of whom 38 (76%) were men. The median injury severity score was 9 (IQR: 3–15) and the median time with a cervical collar from initial application to in-hospital removal or until the interview was given was 91 min (IQR: 72–136). Nineteen patients (38%) reported discomfort and 12 patients (24%) experienced pain related to the immobilisation. Forty patients (80%) reported a sense of protection related to the immobilisation. Conclusion Discomfort related to spinal immobilisation was reported in 38% of trauma patients. However, a sense of protection was a recurring theme in 80% of the trauma patients, who recalled being immobilised. Nearly half of the awake trauma patients had no memory of being immobilised.

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Cervical collar effect on pulmonary volumes in patients with trauma

Cited by 18 publications

References 7 publications

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based

Remaining Cervical Spine Movement Under Different Immobilization Techniques

Patient experience of spinal immobilisation after trauma

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