The effect of axial traction during orotracheal intubation of the trauma victim with an unstable cervical spine.

Axial (in-line) traction is recommended as a stabilizing maneuver during orotracheal intubation of a trauma victim with a potential cervical spine injury. There are no published data demonstrating the safety of this technique in trauma patients with an unstable cervical spine. In our study, 17 victims of blunt traumatic arrest had radiographic analysis of the cervical spine during orotracheal intubation, with and without axial traction. Four (24%) had unstable injuries, which included a C6-7 fracture dislocation, a Hangman's fracture, and two atlanto-occipital dislocations. Axial traction during oral intubation in these victims resulted in a mean distraction at the fracture site of 7.75 mm. Axial traction produced 4 mm of posterior subluxation in the C6-7 fracture dislocation, demonstrating that axial traction alone may result in subluxation, as well as distraction. This depends on the direction of the traction force and integrity of surrounding tissues. We recommend that trauma patients requiring intubation prior to a complete examination and radiographic analysis of the cervical spine be nasotracheally intubated without axial traction, and that the head and neck be stabilized in the neutral position. If a contraindication to nasotracheal intubation exists, a cricothyroidotomy should be performed.