Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions
Abstract
Direct laryngoscopy with manual in-line stabilization is standard of care for acute trauma patients with suspected cervical spine injury. Ethical and methodologic constraints preclude controlled trials of manual in-line stabilization, and recent work questions its effectiveness. We searched MEDLINE, Index Medicus, Web of Knowledge, the Cochrane Database, and article reference lists. According to this search, we present an ancestral review tracing the origins of manual in-line stabilization and an analysis of subsequent studies evaluating the risks and benefits of the procedure. All manual in-line stabilization data came from trials of uninjured patients, cadaveric models, and case series. The procedure was adopted because of reasonable inference from the benefits of stabilization during general care of spine-injured patients, weak empirical data, and expert opinion. More recent data indicate that direct laryngoscopy and intubation are unlikely to cause clinically significant movement and that manual in-line stabilization may not immobilize injured segments. In addition, manual in-line stabilization degrades laryngoscopic view, which may cause hypoxia and worsen outcomes in traumatic brain injury. Patients intubated in the emergency department with suspected cervical spine injury often have traumatic brain injury, but the incidence of unstable cervical lesions in this group is low. The limited available evidence suggests that allowing some flexion or extension of the head is u…
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The primary benefit of a rigid cervical collar is to serve as a reminder about the potential existence of an unstable c-spine injury.
“the primary benefit of a rigid cervical collar is to serve as a reminder about the potential existence of an unstable c-spine injury.”
From Airway Management in Trauma (2018) · cites this paper as [33]
Even in patients with known cervical spine injuries, secondary neurologic deterioration is rare, with a reported incidence of 0.03%.
“even in patients with known cervical spine injuries, secondary neurologic deterioration is rare, with a reported incidence of 0.03%.33,[37][38][39]”
From Airway Management in Trauma (2018) · cites this paper as [33]
The incidence of c-spine injuries is 6%-8% in patients with head and facial trauma.
“and 6%-8% in patients with head and facial trauma)”
From Airway Management in Trauma (2018) · cites this paper as [33]
The incidence of c-spine injuries is approximately 2% in the general trauma population.
“the incidence of c-spine injuries is relatively low (occurring in approximately 2% in the general trauma population”
From Airway Management in Trauma (2018) · cites this paper as [33]
Cited by
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Manoach, S., & Paladino, L.
- Affiliations
- State University of New York (US)
- Corresponding author
- Manoach, Seth
- ORCID
- Paladino, Lorenzo
- Venue
- Annals of Emergency Medicine
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 50
- Issue
- 3
- Pages
- 236-245
- ISSN
- 0196-0644 (ISSN-L)
- OpenAlex
- W2074705029
- Cited by
- 123
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 8 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 8 · 2016: 8 · 2015: 9 · 2014: 7 · 2013: 6 · 2012: 13
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
- Keywords
- manual in-line stabilization, cervical spine injury, direct laryngoscopy, intubation, traumatic brain injury, head immobilization, supraglottic airway devices, video laryngoscopy, emergency department intubation
- MeSH terms
- Cervical Vertebrae, Emergencies, Humans, Intubation, Intratracheal, Laryngoscopy, Spinal Injuries
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