The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization

doi:10.1016/S0736-4679(96)00170-9

The Journal of Emergency Medicine

Volume 14, Issue 5, September–October 1996, Pages 553-559

https://doi.org/10.1016/S0736-4679(96)00170-9 Get rights and content

Abstract

We performed a prospective crossover study to determine the cervical spine immobilization and comfort level of healthy subjects on a full-body vacuum splint in comparison with a standard backboard, with and without cervical spine collars. Twenty-six healthy volunteers were immobilized on a backboard (BB) and a full-body vacuum splint (VS), both with and without a cervical collar (CC). Pre- and post-immobilization cervical spine range-of-motion measurements were made using an electronic digital inclinometer and a standard hand-held goniometer. Subjects were also asked to subjectively grade their immobilization and discomfort both overall and in seven specific body regions. No statistically significant difference was found between the VS+CC and the BB+CC for flexion and rotation, although the VS+CC combination provided significantly superior immobilization to the BB+CC for extension and lateral bending. The VS alone, in all cases except extension, provided superior immobilization to the BB alone. A statistically significant difference in subjective perception of immobilization was noted, with the BB being less effective than the other three alternatives and the VS+CC providing the best immobilization. A significant difference in overall comfort and occipital region comfort, favoring the vacuum splint, was found. In conclusion, the vacuum splint is an effective and more comfortable alternative to the backboard for cervical spine immobilization.

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Cited by (56)

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2019, Wilderness and Environmental Medicine
The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards.
Comparison of tissue-interface pressure in healthy subjects lying on two trauma splinting devices: The vacuum mattress splint and long spine board
2016, Injury
Citation Excerpt :
Currently, most emergency protocols in the United States call for the use of a spine board (SB) when managing trauma patients with suspected spinal injuries. In previous studies, SB’s have been associated with patient discomfort, lack of support for the natural lumbar and cervical lordosis, and a high incidence (up to 30.6%) of pressure ulcers as a result of prolonged, high tissue-interface pressures[1–3]. Recently in some European countries, an alternative splinting device – the vacuum mattress splint (VMS) – has gained popularity.
Most emergency transport protocols in the United States currently call for the use of a spine board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth.
To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3 kPa, and 3) maximal pressure (P_max).
In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3 kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. P_max was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8 kPa, p < 0.001).
This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.
Part 9: First aid. 2015 International Consensus on First Aid Science with Treatment Recommendations
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Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature
2015, Australasian Emergency Nursing Journal
Citation Excerpt :
Four studies were neutral, reporting that immobilisation had no effect on movement when compared to no immobilisation.21,22,30,34 One study produced conflicting results with increases in some movements and decreases in others33 and one study opposed spinal immobilisation reporting increased separation between C1 and C2 when spinal immobilisation was in place.20 Five studies examined the effect of spinal immobilisation on optimal spinal positioning or alignment (Table 5).36–40
Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings.
In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: ‘spinal injuries’ OR ‘spinal cord injuries’ AND ‘emergency treatment’ OR ‘emergency care’ OR ‘first aid’ AND immobilisation. EMBASE was searched for keywords ‘spinal injury OR ‘spinal cord injury’ OR ‘spine fracture AND ‘emergency care’ OR ‘prehospital care’.
There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation.
There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers.
Comparing the Efficacy of Methods for Immobilizing the Thoracic-Lumbar Spine
2018, Air Medical Journal
Citation Excerpt :
In the case of the long spine board, concerns arise from secondary problems seen in some patients. These include pressure sores, reduced sacral tissue oxygen saturation, discomfort, and pain.28-35 For the thoracolumbar spine, standard practice in the Army is to immobilize trauma patients with the use of a long spine board,36 but this practice is not recommended for air medical transport of patients with potentially unstable thoracolumbar fractures.
The purpose of this study was to compare the relative efficacy of immobilization systems in limiting thoracic-lumbar movements.
A dynamic simulation system was used to reproduce transport-related shocks and vibration, and involuntary movements of the thoracic-lumbar region were measured using 3 immobilization configurations.
The vacuum mattress and the long spine board were generally more effective than the cot alone in reducing thoracic-lumbar rotation and flexion/extension. However, the vacuum mattress reduced these thoracic-lumbar movements to a greater extent than the long spine board. In addition, the vacuum mattress significantly decreased thoracic-lumbar lateral movement relative to the cot alone under all simulated transport conditions. In contrast, the long spine board allowed greater lateral movement than the cot alone in a number of the simulated transport rides.
Under the study conditions, the vacuum mattress was more effective for limiting involuntary movements of the thoracic-lumbar region than the long spine board. Moreover, the increased lateral bend observed with the long spine board under some conditions suggests it may be inadequate for immobilizing this anatomic region as presently designed. Should emergency medical service providers choose to immobilize patients with suspected injuries of the thoracic-lumbar spine, study results support the use of the vacuum mattress.

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Original contributionThe efficacy and comfort of full-body vacuum splints for cervical-spine immobilization

Abstract

Ann Emerg Med

J Emerg Med

Br J Plastic Surg

Injury

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Association between pressure sores and immobilization in the immediate postinjury period

Orthopedics

Original contribution
The efficacy and comfort of full-body vacuum splints for cervical-spine immobilization