Research points to changes in the way paramedics approach airway management

A new study from the Ohio State University College of Medicine shows that the way paramedics help people breathe before going to the hospital is changing.

The research, published in JAMA network openedlooks at how emergency medical services (EMS) in the United States manage their patients’ airways. Airway management is used in life-threatening conditions such as cardiac arrest, trauma and respiratory failure.

“Paramedics and emergency medical technicians are usually the first to provide life-saving medical care to critically ill patients,” said Henry Wang, MD, lead author and clinical professor of emergency medicine. “It is important to understand EMS airway management practices so that hospitals know the best method to transfer patients from the ambulance and manage any complications.”

The study analyzed EMS data from the ESO Data Collaborative, one of the largest EMS electronic healthcare systems in the United States. The research team looked at all EMS patient encounters from 2011 to 2022 that attempted advanced airway management, including endotracheal intubation (ETI) and supraglottic airway (SGA).

For more than forty years, ETI – a difficult technique in which a flexible tube is placed into the patient’s lungs through the mouth and vocal cords – has been the dominant technique to help patients breathe. But in the past decade there has been a significant increase in the use of SGA (simpler devices that sit above the vocal cords) in cardiac arrest patients. Now most cardiac arrests are treated with SGA instead of ETI.

“SGA is considered a simpler, faster airway management technique,” ​​said Wang. “You can achieve similar ventilation results with less training.”

Between 2011 and 2022, there were 47.5 million EMS activations for medical emergencies. Of these, 444,041 attempts were made to administer advanced airway management, including 343,312 cardiac arrest cases, 79,358 non-cardiac arrest medical cases, and 21,371 trauma cases.

Among cardiac arrest patients, ETI attempts decreased from 87.3% to 55.1%, while SGA attempts increased from 25.1% to 61% during the study period. SGA attempts in cardiac arrest were higher than ETI between 2020 and 2022. There were similar trends in non-cardiac arrest and trauma patients, albeit to a lesser extent.

“This is the first formal study to confirm that paramedic practice has changed and favors SGA over ETI,” Wang said. “It is important to understand national EMS clinical practices to better allocate emergency resources and improve training.”

Ongoing research through the Pediatric Prehospital Airway Resuscitation Trial led by Wang is working to determine the best method for advanced airway management in children.