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      Analysis of remaining motion using one innovative upper airway opening cervical collar and two traditional cervical collars

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          Abstract

          The aim of this study was to compare the remaining motion of an immobilized cervical spine using an innovative cervical collar as well as two traditional cervical collars. The study was performed on eight fresh human cadavers. The cervical spine was immobilized with one innovative (Lubo Airway Collar) and two traditional cervical collars (Stifneck and Perfit ACE). The flexion and lateral bending of the cervical spine were measured using a wireless motion tracker (Xsens). With the Weinman Lubo Airway Collar attached, the mean remaining flexion was 20.0 ± 9.0°. The mean remaining flexion was lowest with the Laerdal Stifneck (13.1 ± 6.6°) or Ambu Perfit ACE (10.8 ± 5.8°) applied. Compared to that of the innovative Weinmann Lubo Airway Collar, the remaining cervical spine flexion was significantly decreased with the Ambu Perfit ACE. There was no significant difference in lateral bending between the three examined collars. The most effective immobilization of the cervical spine was achieved when traditional cervical collars were implemented. However, all tested cervical collars showed remaining motion of the cervical spine. Thus, alternative immobilization techniques should be considered.

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          Most cited references41

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          Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update.

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            Reduction in mouth opening with semi-rigid cervical collars.

            Reduced mouth opening may be a major contributing factor to the deterioration in the view obtained at laryngoscopy when a semi-rigid cervical collar is in place. We set out to assess the degree to which mouth opening is restricted by a cervical collar. We measured maximal inter-incisor distance in 52 volunteers. It was measured again after application of each of three appropriately sized semi-rigid cervical collars (Stifneck, Miami J, and Philadelphia). Inter-incisor distance was significantly reduced by the application of a cervical collar [No collar 41 (7) mm-mean (SD); Stifneck 26 (8) P<0.0001; Miami J 29 (9) P<0.0001; Philadelphia 29 (9) P<0.0001]. There was a wide and unpredictable variation between subjects in the reduction in mouth opening and a significant proportion had an inter-incisor distance of 20 mm or less (Stifneck, 25%; Miami J, 21%; Philadelphia, 21%). Application of a semi-rigid cervical collar can significantly reduce mouth opening. This could hinder definitive airway placement. Our results support removing the anterior portion of the collar before attempts at tracheal intubation.
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              Spinal immobilisation for trauma patients.

              Spinal immobilisation involves the use of a number of devices and strategies to stabilise the spinal column after injury and thus prevent spinal cord damage. The practice is widely recommended and widely used in trauma patients with suspected spinal cord injury in the pre-hospital setting. To quantify the effect of different methods of spinal immobilisation (including immobilisation versus no immobilisation) on mortality, neurological disability, spinal stability and adverse effects in trauma patients. We searched the Cochrane Controlled Trial Register (CCTR), the specialised register of the Cochrane Injuries Group, MEDLINE, EMBASE, CINAHL, PubMed and the National Research Register. We checked reference lists of all articles and contacted experts in the field to identify eligible trials. Manufacturers of spinal immobilisation devices were also contacted for information. Randomised controlled trials comparing spinal immobilisation strategies in trauma patients with suspected spinal cord injury. Trials in healthy volunteers were excluded. Two reviewers independently applied eligibility criteria to trial reports and extracted data. We found no randomised controlled trials of spinal immobilisation strategies in trauma patients. We did not find any randomised controlled trials that met the inclusion criteria. The effect of spinal immobilisation on mortality, neurological injury, spinal stability and adverse effects in trauma patients remains uncertain. Because airway obstruction is a major cause of preventable death in trauma patients, and spinal immobilisation, particularly of the cervical spine, can contribute to airway compromise, the possibility that immobilisation may increase mortality and morbidity cannot be excluded. Large prospective studies are needed to validate the decision criteria for spinal immobilisation in trauma patients with high risk of spinal injury. Randomised controlled trials in trauma patients are required to establish the relative effectiveness of alternative strategies for spinal immobilisation.
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                Author and article information

                Contributors
                michael.kreinest@bgu-ludwigshafen.de
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                18 October 2021
                18 October 2021
                2021
                : 11
                : 20619
                Affiliations
                [1 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, BG Trauma Center Ludwigshafen, Clinic for Trauma and Orthopaedic Surgery, , University of Heidelberg, ; Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen on the Rhine, Germany
                [2 ]GRID grid.411668.c, ISNI 0000 0000 9935 6525, Clinic for Trauma and Orthopaedic Surgery, , Universitätsklinikum Erlangen, ; Krankenhausstraße 12, 91054 Erlangen, Germany
                [3 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Clinic of Anesthesiology, , University of Heidelberg, ; Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
                Article
                194
                10.1038/s41598-021-00194-w
                8523562
                34663847
                b808935e-463d-4b74-b480-cb7aa060ede7
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 March 2021
                : 24 September 2021
                Categories
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                Custom metadata
                © The Author(s) 2021

                Uncategorized
                preclinical research,musculoskeletal system,trauma
                Uncategorized
                preclinical research, musculoskeletal system, trauma

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