Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr;40(2):73-76.
doi: 10.1017/S1049023X25000238. Epub 2025 Apr 2.

The Effect of Prehospital Protocol Modification during COVID-19 on First-Pass Intubation Success Rates

Abagayle E Bierowski  1   2   3 , Paul C Comber  2   3 , Alexander Kuc  2   3 , Aman Shah  2   3 , Gerard Carroll  2   3
Affiliations

The Effect of Prehospital Protocol Modification during COVID-19 on First-Pass Intubation Success Rates

Abagayle E Bierowski et al. Prehosp Disaster Med. 2025 Apr.

Abstract

Introduction: Many Emergency Medical Services (EMS) agencies modified their protocols during the height of the COVID-19 pandemic, particularly those involving procedures that lead to an increased risk of airborne exposure, such as intubation. In 2020, local Advanced Life Support (ALS) providers' first-line airway management device was the supraglottic airway (SGA), and tracheal intubations (TIs) were rarely performed.

Objective: This study's aim was to investigate the potential clinical effect of this pandemic-related protocol change on first-pass TI success rates and on overall initial advanced airway placement success.

Methods: This study was a retrospective prehospital chart review for all ALS encounters from a single urban EMS agency that resulted in the out-of-hospital placement of at least one advanced airway per encounter from January 1, 2019 through June 30, 2021 (n = 452). Descriptive statistics and chi square tests were used to evaluate data. Statistical significance was defined at P < .05.

Results: Significantly fewer TIs were attempted in 2020 (n = 16) compared to 2019 (n = 80; P < .001), and first-pass TI success rates significantly decreased in 2021 (n = 22; 61.1%) compared to 2019 (n = 63; 78.8%; P = .047). Also, SGA placement constituted 91.2% of all initial airway management attempts in 2020 (n = 165), more than both 2019 (n = 114; 58.8%; P < .001) and 2021 (n = 87; 70.7%; P < .001). Overall first-attempt advanced airway placement success, encompassing both supraglottic and TI, increased from 2019 (n = 169; 87.1%) to 2020 (n = 170; 93.9%; P = .025). Conversely, overall first attempt advanced airway placement success decreased from 2020 to 2021 (n = 104; 84.6%; P = .0072).

Conclusions: Lack of exposure to TI during the COVID-19 pandemic likely contributed to this local agency's decreased first-pass TI success in 2021. Moving forward, agencies should utilize simulation labs and other continuing education efforts to help maintain prehospital providers' proficiency in performing this critical procedure, particularly when protocol changes temporarily hinder or prohibit field-based psychomotor skill development.

Keywords: COVID-19; first-pass success; intubation; prehospital airway management; supraglottic airway.

PubMed Disclaimer

Conflict of interest statement

No sources of support (external funding or otherwise) have been obtained for the conductance of this research. The authors have no financial disclosures to describe, and declare that there is no conflict of interest regarding the publication of this paper. The views and suggestions expressed in this manuscript are of the authors and not of the institution(s) they represent.

Figures

Figure 1.
Figure 1.
Initial Airway Management Modality. Abbreviations: SGA, supraglottic airway; TI, tracheal intubation.
Figure 2.
Figure 2.
First-Pass Success Rates. Note: * Indicates P < .05. Abbreviations: SGA, supraglottic airway; TI, tracheal intubation.
See this image and copyright information in PMC

References

    1. Hart J, Tracy R, Johnston M, et al. Recommendations for prehospital airway management in patients with suspected COVID-19 infection. West J Emerg Med. 2020;21(4):809–812. - PMC - PubMed
    1. Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology. 2020;132(6):1317–1332. - PMC - PubMed
    1. Brewster DJ, Chrimes N, Do TB, et al. Consensus statement: safe airway society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust. 2020;212(10):472–481. - PMC - PubMed
    1. Cheung JCH, Ho LT, Cheng JV, et al. Staff safety during emergency airway management for COVID-19 in Hong Kong. The Lancet. 2020;8(4):E19. - PMC - PubMed
    1. Gleason JM, Christian BR, Barton ED. Nasal cannula apneic oxygenation prevents desaturation during endotracheal intubation: an integrative literature review. West J Emerg Med. 2018;19(2):403–411. - PMC - PubMed

LinkOut - more resources