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Graph from the study showing longitudinal trends in the annual percentage of cardiac arrest endotracheal intubation or supraglottic airway insertion attempts.
By Sarah Roebuck
EMS1
COLUMBUS, Ohio — A new study from The Ohio State University College of Medicine shows that paramedics are changing how they help patients breathe before they arrive at the hospital.
The study, which was published in JAMA Network Open, examined how EMS throughout the country manages their patients’ airways.
“Paramedics and emergency medical technicians are usually the first to provide lifesaving medical care for critically ill patients,” said Henry Wang, MD, lead author and clinical professor of emergency medicine. “It’s important to understand EMS airway management practices so hospitals know the best method to transition patients from the ambulance and manage any potential complications.”
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The study examined EMS data from the ESO Data Collaborative, one of the largest in the U.S., focusing on patient encounters from 2011 to 2022 where advanced airway management, like endotracheal intubation (ETI) and supraglottic airways (SGA), was attempted.
Between 2011 and 2022, there were 47.5 million EMS calls for medical emergencies. Among those, 444,041 involved attempts at advanced airway management, including 343,312 for cardiac arrests, 79,358 for non-cardiac emergencies and 21,371 for trauma cases, according to researchers.
For over 40 years, ETI – a challenging procedure where a tube is placed into the lungs through the mouth – has been the primary method to help patients breathe, researchers stated. However, in the last decade, there’s been a significant shift toward using supraglottic airways SGAs, devices placed above the vocal cords, especially for cardiac arrest patients. Today, most cardiac arrests are managed with SGA instead of ETI.
“SGA is considered to be a simpler, faster airway management technique,” Wang said. “You can achieve similar ventilation results with less training.”
During the study period, ETI attempts for cardiac arrest patients decreased from 87.3% to 55.1%, while SGA attempts increased from 25.1% to 61%. From 2020 to 2022, SGA was used more often than ETI for cardiac arrests. Similar trends were observed in non-cardiac and trauma patients, though less pronounced.
“This is the first formal study confirming that paramedic practice has changed to favor SGA over ETI,” Wang said. “It is important to understand national EMS clinical practices to better allocate emergency resources and improve training.”
Want is currently leading ongoing research to determine the best method of advanced airway management in children.
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