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Background <p>Airway management is critical in prehospital care. This study quantified first pass success (FPS) for endotracheal intubation (ETI) in a Swiss emergency medical service (EMS) and identified factors associated with success.</p> Methods <p>All adult (≥ 18&#xa0;years) ETI attempts documented in the EMS database between 1 January 2021 and 31 December 2024 were reviewed. Devices [direct laryngoscopy, standard-geometry videolaryngoscope (VL), hyperangulated VL], adjuncts [bougie, stylet], operators [critical-care paramedic (CCP), emergency physician (EP)] and setting were analyzed. The primary outcome was FPS; predictors were evaluated with univariate and multivariable logistic regression.</p> Results <p>ETI was attempted in 270 patients (mean age 67.9 ± 16.4&#xa0;year; 64.8% male); 55.6% intubations occurred during cardiopulmonary resuscitation. Overall FPS was 92.6% (250/270). Bougie use achieved 100% (49/49) FPS versus 91.0% (201/221) with a stylet (<i>p</i> = 0.03). Device-specific FPS was 94.3% (33/35, direct laryngoscopy), 94.0% (173/184, standard-geometry VL) and 86.3% (44/51, D-BLADE VL). FPS was significantly associated with D-BLADE VL use in patients with an anticipated difficult intubation (89,7% FPS, <i>p</i> &lt; 0.001). CCP showed higher odds for FPS for CCP compared to EP (OR 3.61, 95% CI 1.14 to 11.45).</p> Conclusions <p>Bougie-assisted laryngoscopy was significantly associated with higher first pass success rates. When a difficult airway was anticipated, the hyperangulated D-BLADE videolaryngoscope showed higher odds for first pass success. Critical-care paramedics achieved first pass success rates comparable to those of emergency physicians.</p> Trial registration <p>Clinical Trials.gov: NCT06653166 (19 October 2024).</p>

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Airway management analysis in the rescue environment of the emergency service Zug: a retrospective real-world evaluation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月22日

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  • Felix Brinkmann,
  • Gian Cajoeri,
  • Sebastian Daniel Sahli,
  • Philipp Karl Buehler,
  • Benedikt Florian Scherr

摘要

Background

Airway management is critical in prehospital care. This study quantified first pass success (FPS) for endotracheal intubation (ETI) in a Swiss emergency medical service (EMS) and identified factors associated with success.

Methods

All adult (≥ 18 years) ETI attempts documented in the EMS database between 1 January 2021 and 31 December 2024 were reviewed. Devices [direct laryngoscopy, standard-geometry videolaryngoscope (VL), hyperangulated VL], adjuncts [bougie, stylet], operators [critical-care paramedic (CCP), emergency physician (EP)] and setting were analyzed. The primary outcome was FPS; predictors were evaluated with univariate and multivariable logistic regression.

Results

ETI was attempted in 270 patients (mean age 67.9 ± 16.4 year; 64.8% male); 55.6% intubations occurred during cardiopulmonary resuscitation. Overall FPS was 92.6% (250/270). Bougie use achieved 100% (49/49) FPS versus 91.0% (201/221) with a stylet (p = 0.03). Device-specific FPS was 94.3% (33/35, direct laryngoscopy), 94.0% (173/184, standard-geometry VL) and 86.3% (44/51, D-BLADE VL). FPS was significantly associated with D-BLADE VL use in patients with an anticipated difficult intubation (89,7% FPS, p < 0.001). CCP showed higher odds for FPS for CCP compared to EP (OR 3.61, 95% CI 1.14 to 11.45).

Conclusions

Bougie-assisted laryngoscopy was significantly associated with higher first pass success rates. When a difficult airway was anticipated, the hyperangulated D-BLADE videolaryngoscope showed higher odds for first pass success. Critical-care paramedics achieved first pass success rates comparable to those of emergency physicians.

Trial registration

Clinical Trials.gov: NCT06653166 (19 October 2024).