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Spinal motion restriction: FA 7311 TF ScR

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This CoSTR is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final COSTR will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: none applicable

The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: none applicable

Task Force Synthesis Citation

Laermans J, Djärv T, Singletary EM, Macneil F, Williamson F, Cimpoesu D, Flores G on behalf of the International Liaison Committee on Resuscitation First Aid Task Force.

Spinal motion restriction Task Force Synthesis of a Scoping Review [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) First Aid Task Force, 2024 October 28. Available from: http://ilcor.org

Methodological Preamble and Link to Published Scoping Review

A scoping review of cervical spinal motion restriction was conducted by the ILCOR First Aid Task Force Scoping Review team, taking into consideration the work previously done within the First Aid Task Force in 2015 (systematic review) and 2019 (two scoping reviews). Evidence from the literature published during the last 25 years (1999-2024) was sought and considered by the First Aid Task Force.

Scoping Review

Webmaster to insert the Scoping Review citation and link to Pubmed using this format when/if it is available.

PICOST

The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe)

Population: Adults and children with possible traumatic cervical spinal injury.

Intervention: Cervical spinal motion restriction performed by a (trained) first aider.

Comparators: No cervical spinal motion restriction, or another type of cervical spinal motion restriction.

Outcomes: Any clinical outcome.

Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies) and case series were eligible for inclusion. Case reports and studies performing a single measurement of the outcome (e.g. feasibility study, proof-of-concept study) were excluded.
Grey literature and social media and non-peer reviewed studies, unpublished studies, conference abstracts and trial protocols were not eligible for inclusion as there was an abundant evidence base from published studies. All relevant publications in any language were included as long as there was an English abstract.

Timeframe: 1999-2024.

Literature search updated to July 31, 2024.

Search Strategies: FA 7311 Spinal motion restriction Appendix 1 search strategy

A search strategy was developed with assistance from Mark S. McKone, an information specialist at the Wake Forest School of Medicine Coy C. Carpenter Library in Winston-Salem, North Carolina, USA (see Appendix 1). Articles for review were obtained by searching the following databases, with final searches ran on July 31, 2024: Ovid MEDLINE(R) ALL <1946 to July 31, 2024>, Embase <1974 to 2024 July 30> and CINAHL Plus with Full text (1936 – Present) via EBSCOhost.

Records from the database searches were downloaded and imported into Covidence for removal of duplicates and screening. A total of 2291 records were retrieved, and after removing 977 duplicates, 1314 records remained for the title and abstract screening. After excluding 1226 records, a total of 87 full texts were screened (see Appendix 2 for PRISMA flow chart).
Additional studies were identified by screening reference lists of the included studies, and by screening the included studies of systematic reviews and scoping reviews retrieved via the database searches and reference list screening (listed in Appendix 3). Finally, the members of the ILCOR First Aid Task Force were asked to review the list and provide additional studies for review to ensure there were no obvious omissions. These other resources led to the full text screening of 131 additional records and finally led to the inclusion of 34 studies (see Appendix 2). FA 7311 Spinal motion restriction Appendix 2 flowchart; FA 7311 Spinal motion restriction Appendix 3 List of Sc R and SR

Inclusion and Exclusion criteria


Population

Included:

  • Adults or children with possible cervical spinal injury due to non-penetrating trauma.
  • Studies in healthy volunteers.
  • Studies in human cadavers.

Excluded:

  • Adults or children with penetrating trauma.

Intervention

Included:

Spinal motion restriction was defined as ‘attempting to maintain the spine in anatomic alignment and minimizing gross movement, with or without adjuncts or devices’.

  • Studies were included if they met all of the following criteria (a, b and c):
  • Motion restriction was performed at the level of the cervical spine, with or without restriction at the level of the lower (i.e. thoracic, lumbar and sacral) spine;
  • Devices used for motion restriction are commonly and readily available to (trained) first aiders. Discussions within the Task Force revealed that the types of devices that first aiders are trained to use vary largely between countries and between settings within countries, on top of the varying availability of those devices themselves. For instance, in the US, ski patrollers are trained in the use of a long backboard and many use vacuum mattresses. As a result, a wide range of devices was considered relevant for inclusion in this scoping review:
  • Any type of improvised or commercially available cervical collar (soft, semi-rigid or rigid);
  • Long backboard;
  • Head blocks;
  • Straps;
  • Vacuum mattress;
  • Scoop stretcher.
  • Uninstructed self-extrication with no cervical collar versus uninstructed self-extrication with a cervical collar;
  • Uninstructed self-extrication (with or without a cervical collar) versus instructed self-extrication (with or without a cervical collar).

Excluded:

  • Studies that did not concern motion restriction at the level of the cervical spine (e.g. thoracic spinal motion restriction).
  • Studies using devices that are not commonly and readily available to (trained) first aiders, such as:
  • The Kendrick extrication device;
  • The Pediatric Immobilization and Extrication System (SIPE) Baby Rescuer device;
  • The Halo vest;
  • The Minerva jacket.

Outcomes

Included:
Any clinical outcome related to the patient, including:

  • Incidence of (secondary) spinal injury;
  • Cervical (range of) motion;
  • Functional outcomes and/or survival;
  • Length of hospital stay;
  • Adverse effects of spinal motion restriction occurring within 24 hours after the injury (i.e. on the way to the emergency department or inside the emergency department), including effects on:
  • Intracranial, cerebrospinal fluid or cerebral perfusion pressure;
  • Respiratory function;
  • Cardiovascular function;
  • Pain and discomfort.

Excluded:

  • Adverse effects of spinal motion restriction that were delayed or occurred after admission to a hospital associated with prolonged immobilization (e.g. skin breakdown, formation of pressure ulcers after days in the Intensive Care Unit or hospital ward).
  • Studies reviewing the effect of spinal motion restriction on ease of intubation with different airway devices or laryngoscopes, or on the ease of performing vertebroplasty, laminectomy or other surgical interventions.

Data tables

See Appendix 4 (extracted data) and Appendix 5 (equity-relevant data using the PROGRESS-Plus framework).FA 7311 Spinal motion restriction Appendix 4 Extracted data; FA 7311 Spinal motion restriction Appendix 5 Equity

Task Force Insights:

FA 7311 task force insights appendix 7

Knowledge Gaps

The First Aid Task Force noted the following knowledge gaps requiring further research:

  • There were no studies that evaluated the benefits and harms of spinal motion restriction in conscious persons, performed by untrained or trained first aiders.
  • There were no studies that evaluated the effectiveness of spinal motion restriction by first aiders in unconscious persons.
  • There were only two studies that looked at methods for spinal motion restriction that could be applied specifically in low-resource settings (e.g. a folded fleece jacket as an improvised collar, a folded towel wrapped around the neck and crossed around the chest).

References

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