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Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department—a systematic review
  1. J E Ollerton,
  2. M J A Parr,
  3. K Harrison,
  4. B Hanrahan,
  5. M Sugrue
  1. Liverpool Hospital, Sydney, Australia
  1. Correspondence to:
 J E Ollerton
 Department of Trauma, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia; j.ollerton{at}


Background: Emergency airway management for trauma adults is practised by physicians from a range of training backgrounds and with differing levels of experience. The indications for intubation and technique employed are factors that vary within EDs and between hospitals.

Objectives: To provide practical evidence based guidance for airway management in trauma resuscitation: first for the trauma adult with potential cervical spine injury and second the management when a difficult airway is encountered at intubation.

Search strategy and methodology: Full literature search for relevant articles in Medline (1966–2003), EMBASE (1980–2003), and the Cochrane Central Register of Controlled Trials. Relevant articles relating to adults and written in English language were appraised. English language abstracts of foreign articles were included. Studies were critically appraised on a standardised data collection sheet to assess validity and quality of evidence. The level of evidence was allocated using the methods of the Australian National Health and Medical Research Council.

  • c-spine, cervical spine
  • ED, emergency department
  • LMA, laryngeal mask airway
  • MERGE, method of evaluating research and guideline evidence
  • MILS, manual in-line stabilisation
  • NHMRC, National Health and Medical Resource Council
  • RSI, rapid sequence induction and intubation
  • emergency airway management
  • trauma
  • cervical spine
  • difficult airway

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  • Funding: none.

  • Competing interests: none declared.