Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers

Maissan, Iscander M.; Ketelaars, Rein; Vlottes, Boris; Hoeks, Sanne E.; Hartog, Dennis den; Stolker, Robert Jan

doi:10.1097/mej.0000000000000490

Cited by 32 publications

(14 citation statements)

References 21 publications

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“…The hypothesis states that fluid shifts have the potential to increase the ICP during deceleration of the moving ambulance due to increased venous stasis and backflow in the head. A similar mechanism has been proven to increase the ICP and optical nerve sheath diameter (ONSD) in Trendelenburg position and after application of a rigid cervical collar [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational proof of principle study

Maissan

Vlottes

Hoeks

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Ambulance drivers in the Netherlands are trained to drive as fluent as possible when transporting a head injured patient to the hospital. Acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. Although the idea of fluid shift during braking causing intra cranial pressure (ICP) to rise is widely accepted, it lacks any scientific evidence. In this study we evaluated the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30° upright position. Methods Participants were placed on the ambulance gurney in supine position. During driving and braking the optical nerve sheath diameter (ONSD) was measured with ultrasound. Because cerebro spinal fluid percolates in the optical nerve sheath when ICP rises, the diameter of this sheath will distend if ICP rises during braking of the ambulance. The same measurements were taken with the headrest in 30° upright position. Results Mean ONSD in 20 subjects in supine position increased from 4.80 (IQR 4.80–5.00) mm during normal transportation to 6.00 (IQR 5.75–6.40) mm (p < 0.001) during braking. ONSD’s increased in all subjects in supine position. After raising the headrest of the gurney 30° mean ONSD increased from 4.80 (IQR 4.67–5.02) mm during normal transportation to 4.90 (IQR 4.80–5.02) mm (p = 0.022) during braking. In 15 subjects (75%) there was no change in ONSD at all. Conclusions ONSD and thereby ICP increases during deceleration of a transporting vehicle in participants in supine position. Raising the headrest of the gurney to 30 degrees reduces the effect of breaking on ICP.

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Section: Introductionmentioning

confidence: 99%

Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational proof of principle study

Maissan

Vlottes

Hoeks

et al. 2021

Scand J Trauma Resusc Emerg Med

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“…Spinal stabilisation has also been associated with tissue ischemia and even an increased risk of pressure ulcers with prolonged use, [4] as well as an increased intracranial pressure [14–16].…”

Section: Discussionmentioning

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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“…They He studied healthy volunteers including 22 male and 23 female volunteers. They observed application of a collar resulted in a significant increase optic nerve sheath diameter in both side and concluded application of a rigid cervical collar significantly increases the optic nerve sheath diameter in healthy volunteers with intact cerebral autoregulation (12).…”

Section: Effect On Intracranial Pressurementioning

confidence: 98%

Magnitude of Intracranial Pressure Changes Following Rigid External Cervical Collar Immobilization in Cases Sustaining Traumatic Brain Injury: Impact Analysis Current Status

Satyarthee¹,

Moscote-Salazar²,

Agrawal³

2018

Romanian Neurosurgery

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Rigid collars are routinely used to immobilise the cervical spine during early phase of management of trauma cases until cervical clearance is obtained or else diagnosed as case of cervical spine injury following detailed clinical as well as neurological evaluation. Spinal injuries commonly coexist in patients sustaining severe head injury. Till date, there is no clear cut consensus about effect of application of a rigid collar in cases suffering with traumatic brain injury. However, concern are regularly raised over collar application, such practice may have adverse effect on cerebrovascular regulation and ultimately affecting intracranial pressure and outcome. Authors made detailed Pubmed, EMBASE, AMED, and Thomson Reuters, Medline line search and could find out six articles. According to existing literature, the cervical collar has the potential to influence intracranial pressure in patients suffering with head injury. There are several reports in the literature showing that cervical immobilization may alter intracranial pressure and the changes in ICP closely depend on the types of cervical collars used. Authors discuss the current status based on review of updated literature on possible effect on the intracranial pressure produced by application of rigid cervical collar and briefly literature is reviewed.

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Increase in intracranial pressure by application of a rigid cervical collar: a pilot study in healthy volunteers

Cited by 32 publications

References 21 publications

Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational proof of principle study

Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational proof of principle study

Patient experience of spinal immobilisation after trauma

Magnitude of Intracranial Pressure Changes Following Rigid External Cervical Collar Immobilization in Cases Sustaining Traumatic Brain Injury: Impact Analysis Current Status

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