Abstract：
BACKGROUND: There are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting.
METHODS: An expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012-June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury.
RESULTS: We included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors.
CONCLUSIONS: It is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.
METHODS: An expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012-June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury.
RESULTS: We included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors.
CONCLUSIONS: It is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.
摘要：
背景：对于疑似或确诊颈椎损伤的患者，人们担心气道管理可能会加剧现有的神经功能缺损，引起新的脊髓损伤或由于避免神经损伤的预防措施而危险。然而,在这种情况下,临床医师没有基于证据的指南来支持安全有效的气道管理.
方法：多学科专家，多社会工作组对当代文学进行了系统的审查(2012年1月至2022年6月)，随后进行了三轮Delphi程序，以制定指南，以改善疑似或确诊颈椎损伤患者的气道管理。
结果：我们在系统综述中纳入了67篇文章，并成功地商定了23项建议。支持建议的证据通常很少，只提出了一个温和的建议和两个强烈的建议。总的来说,建议重点介绍了预氧合和面罩通气的关键原则和技术；声门上气道装置的使用；气管插管；气管插管期间的辅助手段；环状软骨力和外部喉部操作；紧急前颈气道通路；清醒气管插管；和颈椎固定。我们还指出了院前护理的建议，人为因素中的军事设置和原则。
结论：希望在这些指南中提出的务实的气道管理方法将提高疑似或确诊颈椎损伤的成年患者气道管理的安全性和有效性。
方法：多学科专家，多社会工作组对当代文学进行了系统的审查(2012年1月至2022年6月)，随后进行了三轮Delphi程序，以制定指南，以改善疑似或确诊颈椎损伤患者的气道管理。
结果：我们在系统综述中纳入了67篇文章，并成功地商定了23项建议。支持建议的证据通常很少，只提出了一个温和的建议和两个强烈的建议。总的来说,建议重点介绍了预氧合和面罩通气的关键原则和技术；声门上气道装置的使用；气管插管；气管插管期间的辅助手段；环状软骨力和外部喉部操作；紧急前颈气道通路；清醒气管插管；和颈椎固定。我们还指出了院前护理的建议，人为因素中的军事设置和原则。
结论：希望在这些指南中提出的务实的气道管理方法将提高疑似或确诊颈椎损伤的成年患者气道管理的安全性和有效性。
