Cervical spine clearance and neck extension during percutaneous tracheostomy in trauma patients

Introduction: The lack of cervical spine clearance and inability to extend the neck are assumed to be relative contraindications for percutaneous trac heostomy. Objective: To determine the necessity of cervical spine clearance and neck extension in trauma patients receiving percutaneous tracheostomy. Design: Prospective analysis of case series from August 1, 1995 to August 3 1, 1998. Setting: A university-based Level I trauma center. Patients: A total of 88 consecutive trauma patients receiving percutaneous tracheostomy, Patients were divided into two groups based an the radiograph ic or clinical status of their cervical spine: cleared and noncleared. Resu lts: The overall success and complication rate were 99% (87/88) and 11% (10 /88), respectively. There were no procedure-related deaths. The cleared gro up consisted of 60 patients; three patients in this group who had "bull" or "thick" necks did not have full neck extension during percutaneous tracheo stomy, The noncleared group consisted of 28 patients, 13 of which had known cervical spine fractures; 27 noncleared patients were maintained in the ne utral position (no extension) during percutaneous tracheostomy, whereas one patient with tow suspicion of spinal injury was partially extended, Of the 13 patients with cervical spine fractures, six patients had been stabilize d with a halo or operative fixation, and seven patients were stabilized wit h a cervical collar at the time of percutaneous tracheostomy, The success r ate was 100% (60/60) for the cleared group compared with 96% (27/28) for th e noncleared group (p > .05), The complication rate was 13% (8/60) far the cleared group compared with 7.1% (2/28) for the noncleared group (p > .05), We had a 100% success rate and no complications in the seven patients with cervical spine injury who were stabilized with a cervical collar. No patie nt had spinal cord injury caused by percutaneous tracheostomy, Conclusion: Percutaneous tracheostomy can be safety performed in trauma pat ients without cervical spine clearance and neck extension, including patien ts with stabilized cervical spine or spinal cord injury.