Airway management in patients with unstable cervical spine fractures

We conducted a retrospective study of traumatic, unstable cervical spine fractures requiring operative repair to determine the airway management technique and whether any neurologic complication resulted from the intubation. One hundred thirty-three patients with 140 fractures were reviewed relative to fracture site, oral versus nasal route of intubation, and location of intubation (surgery versus emergency department or field). Fracture site incidence was determined as follows: C-1, ten (7.1%); odontoid/C-2, 17 (12.1%); C-3, eight (5.7%); C-4, 21 (15.0%); C-5, 41 (29.2%); C-6, 38 (27.1%); and C-7, five (3.5%). Ten of the injuries resulted from blows to the neck or head, 25 from falls, seven from diving, and six from sports-related injuries. The remaining eighty-five patients were in motor vehicle accidents. Nine patients were nasally intubated in the ED, and one patient was orally intubated in the field. Ninety-four of the patients intubated in surgery were intubated nasally: 29 were intubated orally while in-line stabilization was maintained. No neurologic complications occurred in any patient. These data suggest that, under controlled circumstances, patients with unstable cervical spine fractures can be safely intubated with standard, nonsurgical approaches.