Analysis of factors associated with emergency airway intervention after extubation in patients surgically treated for traumatic cervical spinal cord injury without planned prophylactic airway management.

BACKGROUND: Patients with traumatic cervical spinal cord injury (tCSCI) often require airway management to ensure proper pulmonary hygiene and suctioning due to accumulation of secretions. This phenomenon is caused by the combined loss of sympathetic nerve activity, leading to increased bronchial tone and mucous secretion, and weakened expiratory muscles and reduced coughing function. However, the factors contributing to the need for emergency airway intervention following surgery for tCSCI are not fully elucidated. AIMS: The current study aimed to investigate the factors associated with the need for emergency airway intervention after postoperative extubation for tCSCI. METHODS: The medical records of patients who underwent surgery for tCSCI between January 2015 and October 2025 were reviewed. The patients who underwent planned prophylactic airway management were excluded. The primary outcome was the need for emergency airway intervention after extubation. RESULTS: Of the 221 patients included in this analysis, 51 (23%) required emergency airway intervention. In the multivariable logistic regression analysis, neurogenic shock, complete motor impairment, and vertebral artery injury were significantly associated with the need for emergency airway intervention. The rates of emergency airway intervention were 100%, 70%, 24%, and 3% for patients with all, two, one, or no factors, respectively. CONCLUSIONS: In patients with tCSCI who were extubated postoperatively without planned airway management, the presence of neurogenic shock, complete motor impairment, and vertebral artery injury may help stratify the risk of emergency airway intervention.