UMEM Educational Pearls

Title: Do Cervical Collars Increase ICP in TBI?

Category: Neurology

Keywords: traumatic brain injury, intracranial pressure, cervical collar, immobilization (PubMed Search)

Posted: 4/23/2020 by WanTsu Wendy Chang, MD (Updated: 11/23/2024)
Click here to contact WanTsu Wendy Chang, MD

A number of small studies in the past suggested that cervical collars can increase intracranial pressure (ICP) in patients with traumatic brain injury (TBI).
In patients with severe head injury with poor intracranial compliance and impaired cerebral autoregulation, compression on the jugular veins may result in an increase in jugular venous pressure, increase in ICP, and decrease cerebral perfusion.
A recent meta-analysis included 5 studies comprising 86 adult patients with moderate-severe TBI.
3 studies used rigid collars (Stifneck), while 1 used semi-rigid, and 1 used a mix of cervical collars.
All 5 studies monitored ICP before and after collar application, 2 also monitored ICP after collar removal.
Cervical collar application was associated with an overall ICP increase of approximately 4.4 mmHg (95%CI 1.70, 7.17; p<0.01), while removal was associated with an overall decrease of approximately 3 mmHg (95%CI -5.45, -0.52; p=0.02).
The use of rigid cervical collars was strongly associated with raised ICP compared to semi-rigid collars (WMD=4.86; 95%CI 2.13, 7.60; p<0.01).

Bottom Line: Cervical collars can increased ICP in moderate-severe TBI. In patients with poor cerebral compliance and impaired cerebral autoregulation, even a small increase in ICP can affect cerebral perfusion.

References

Nunez-Latino RA, Rubiano AM, Godoy DA. Impact of cervical collars on intracranial pressure values in traumatic brain injury: a systematic review and meta-analysis of prospective studies. Neurocrit Care. 2020;32(1):469-77.

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