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Observational Study
. 2025 Jun 23;33(1):109.
doi: 10.1186/s13049-025-01422-2.

Success of airway management in out-of-hospital cardiac arrest using different devices - a prospective, single-center, observational study comparing professions

Nils Brenne  1   2 , Niclas Brünjes  1   3 , Dennis Rupp  4 , Martin Christian Sassen  5   6 , Andreas Jerrentrup  7 , Hinnerk Wulf  1 , Nils Heuser #  1 , Christian Volberg #  8
Affiliations
Observational Study

Success of airway management in out-of-hospital cardiac arrest using different devices - a prospective, single-center, observational study comparing professions

Nils Brenne et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Endotracheal intubation is the gold standard for airway management in out-of-hospital cardiopulmonary resuscitation (CPR) but requires practice, especially in difficult conditions. To facilitate this, video laryngoscopy (VL) is increasingly used. The extent to which it is actually used in practice by paramedics or emergency physicians (EPs) and its effectiveness remain unclear. This prospective observational study investigates these aspects.

Methods: From January 2020 to June 2024, we surveyed emergency physicians and paramedics in a German county about out-of-hospital resuscitations. The questionnaire covered qualifications, airway devices, attempts, and complications. Data was analyzed descriptively and statistically. The significance level was set at alpha ≤ 0.05.

Results: 301 questionnaires were analyzed, with an overall first pass success (FPS) rate of 62.8%. No significant difference was found between direct laryngoscopy (DL) and video laryngoscopy (VL), though VL with McGrath performed worse than DL and VL with C-Mac. FPS rates did not differ significantly between emergency physicians and paramedics. Both achieved better results with their regularly used device. Paramedics used laryngeal masks more frequently (34% vs. 1.5%, p < 0.001). Among emergency physicians, anesthetists had the lowest FPS using DL (p < 0.001).

Interpretation: The FPS rate did not differ between DL and VL but was low overall. This low rate, as well as the fact that emergency physicians and paramedics achieved comparable results in intubation, might indicate an increased need for training and further education in the area of airway management for emergency personnel. However, it can also be questioned to what extent ETI can be recommended at all, with supraglottic devices being an alternative. A possible benefit of more training can be seen in the higher success rates with the more frequently used devices in both professions. An uncertainty of paramedics regarding endotracheal intubation is also reflected in an more frequent use of laryngeal masks. The fact that internists who used VL more frequently had better FPS rates than anesthetists who intubated conventionally more often shows the potential of VL, especially under difficult out-of-hospital intubation conditions.

Trial registration: The study was registered in the German Clinical Trials Register (DRKS ID: DRKS00021821, 12.06.2020).

Keywords: Airway management; Emergency medical services; Endotracheal intubation; Out-of-hospital cardiac arrest; Video laryngoscopy.

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Conflict of interest statement

Declarations. Ethical approval: Positive vote of the ethics board of the Philipps University of Marburg, Germany from 02/09/2019 (Ethics Committee processing number: 134/19). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
First to fifth pass success rates overall and for different devices
Fig. 2
Fig. 2
First pass usage overall and by different professions
Fig. 3
Fig. 3
Factors leading to complications
See this image and copyright information in PMC

References

    1. Fischer M, Wnent J, Gräsner J-T, Seewald S, Rück L, Hoffmann H, Bein B, Ramshorn-Zimmer A, Bohn A. & Die teilnehmenden rettungsdienste im, Deutschen reanimationsregister. Öffentlicher Jahresbericht 2023 des Deutschen Reanimationsregisters: Außerklinische Reanimation 2023 [Internet]. 2024. Verfügbar unter: https://www.reanimationsregister.de/downloads/oeffentliche-jahresbericht...
    1. Hasegawa K, Shigemitsu K, Hagiwara Y, Chiba T, Watase H, Brown CA. u. A. Association between repeated intubation attempts A.d adverse events in emergency departments: an analysis of A.Multicenter prospective observational study. Ann Emerg Med Dezember. 2012;60(6):749–e7542. - DOI - PubMed
    1. Mort TC. Complications of emergency tracheal intubation: hemodynamic Alterations - Part I. J Intensive Care Med Mai. 2007;22(3):157–65. - DOI - PubMed
    1. Murphy DL, Bulger NE, Harrington BM, Skerchak JA, Counts CR, Latimer AJ. u. A. Fewer tracheal intubation A.tempts A.e A.sociated with improved neurologically intact survival following out-of-hospital cardiac A.rest. Resusc Oktober. 2021;167:289–96. - PubMed
    1. Timmermann A. S1-Leitlinie: prähospitales atemwegsmanagement (Kurzfassung). Timmermann böttiger BW Byhahn C Dörges V Eich C Gräsner JT al S1-Leitlin prähospitales atemwegsmanagement Kurzfass. 7 Juni 2019;(6–2019):316–36.

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