What is the appropriate management for a neck injury using the jaw thrust (mandibular displacement) maneuver?

From the Guidelines

The appropriate management for a neck injury using the jaw thrust (mandibular displacement) maneuver is to use it as the initial technique to open the airway in patients with suspected or confirmed cervical spine injury, as it causes less cervical spine movement compared to the head tilt-chin lift maneuver [1].

Key Points

• The jaw thrust maneuver should be used instead of head tilt-chin lift to minimize cervical spine movement [1].
• If the jaw thrust is ineffective, a head tilt-chin lift may be used as a last resort to open the airway, despite the potential risk of further spinal damage [1].
• Maintaining a patent airway and providing adequate ventilation and oxygenation are priorities, and the need to open the airway outweighs the risk of further spinal damage in cardiac arrest patients [1].
• The use of high-flow nasal oxygen (HFNO) for pre- and peri-oxygenation may be considered, but with caution in patients with suspected or confirmed base of skull fractures [1].
• Regular training in the use of videolaryngoscopy with cervical spine immobilization is recommended for clinicians who perform tracheal intubation in patients with suspected or confirmed cervical spine injury [1].

Important Considerations

• The jaw thrust maneuver is widely accepted as an effective way to open the airway and theoretically limits cervical motion compared to the head tilt-chin lift [1].
• There is a dearth of robust evidence on the use of facemask and HFNO in patients with suspected or confirmed cervical spine injury, and more research is required [1].

From the Research

Appropriate Management for Neck Injury using Jaw Thrust Maneuver

The jaw thrust maneuver is a critical airway management technique used in patients with suspected cervical spine injury. The following points highlight the appropriate management for a neck injury using this maneuver:

• The jaw thrust maneuver results in less motion at an unstable C1-C2 injury as compared with the head tilt-chin lift maneuver, making it a safer option for patients with suspected cervical spine injury 2.
• The use of the jaw thrust maneuver is recommended to improve airway patency in trauma patients with suspected cervical spine injury 2.
• The jaw thrust maneuver can be used in conjunction with other airway management techniques, such as laryngeal mask airway (LMA) insertion, and does not complicate the insertion process even with chest compression and/or cervical stabilization 3.
• The two-handed E-C technique with the head fully extended and the jaw thrust technique both produce good and comparable tidal volumes, making them effective alternatives for airway management in patients with suspected cervical spine injury 4.
• However, the jaw thrust maneuver can be associated with rare complications, such as transient bradycardia leading to asystole, due to the vagal response to pain induced by the maneuver 5.
• Every airway maneuver, including the jaw thrust, will cause some degree of neck movement, and significant cervical spine motion can be induced by bag-mask ventilation, even in living humans 6.

Key Considerations

• The jaw thrust maneuver should be performed carefully to minimize motion at the injured level and prevent further injury to the cervical spine.
• The use of cervical immobilization collars can help reduce motion at the injured level during airway management.
• Alternative airway management techniques, such as the two-handed E-C technique with the head fully extended, can be considered in patients with suspected cervical spine injury.
• The potential risks and complications associated with the jaw thrust maneuver, such as bradycardia and asystole, should be carefully monitored and managed.