59.Issue 08 august 25 - INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES

Volume : 12, Issue : 08, August- 2025

Title:

PREHOSPITAL AIRWAY MANAGEMENT: A SYSTEMATIC REVIEW OF TECHNIQUES AND OUTCOMES

Authors :

Ali Barakat Ahmed Al-Shomrani, Muhammad Salem Farhan Al-Qarni, Sinan Ahmed Hassan Al-Amari, Awad Ali Ghaythan Alkethere, Saleh Ahmed Saleh Al-Montashari, Abdullah Mohammed Ali Alqarni, Mohammed Ahmed Belqasem Shamrani, Abdul Khaleq Ahmed Hassan Al Hassan, Mhadi Saadi Mohammed Alzahrani, Saeed Sarrah Hubyash Alamri

Abstract :

Objective: This systematic review and meta-analysis aims to synthesize the current evidence on the efficacy, safety, and patient outcomes associated with different prehospital airway management techniques, including bag-valve-mask (BVM) ventilation, endotracheal intubation (ETI), and supraglottic airways (SGAs).
Methods: A systematic search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus was conducted for randomized controlled trials and observational studies from inception to the present. Studies comparing advanced airway management (ETI or SGA) to BVM or to each other in prehospital patients were included. Primary outcomes were survival to hospital discharge and survival with a favourable neurological outcome. Study quality was assessed using the Cochrane RoB 2 tool and the Newcastle-Ottawa Scale.
Results: Twenty-three studies with a total of over 1.2 million patients were included. Meta-analysis revealed no significant difference in survival to hospital discharge between advanced airways (ETI or SGA) and BVM ventilation (RR 1.08, 95% CI 0.92 to 1.27). However, the use of advanced airways was associated with a statistically significant reduction in the likelihood of a favourable neurological outcome compared to BVM (RR 0.86, 95% CI 0.78 to 0.95). SGAs demonstrated a higher first-pass success rate (92%) and shorter placement time than ETI (78%).
Conclusion: In patients with out-of-hospital cardiac arrest, advanced airway management (ETI or SGA) is associated with worse neurological outcomes compared to BVM ventilation, despite no difference in survival. The findings advocate for a paradigm shift towards optimizing BVM ventilation as a first-line strategy. When an advanced airway is necessary, SGAs may be a more practical option than ETI due to higher success rates and faster placement.
Keywords: Prehospital Emergency Care, Airway Management, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest, Emergency Medical Services.

Cite This Article:

Please cite this article in press Ali Barakat Ahmed Al-Shamrani et al., Prehospital Airway Management: A Systematic Review Of Techniques And Outcomes., Indo Am. J. P. Sci, 2025; 12(08).

Number of Downloads : 10

References:

1. Abe, T., Nagata, T., Hasegawa, M., & Hagihara, A. (2020). The effect of prehospital advanced airway management on outcomes after out-of-hospital cardiac arrest in patients with non-shockable rhythms. Resuscitation, 146, 123–130. https://doi.org/10.1016/j.resuscitation.2019.09.006
2. Benger, J. R., Kirby, K., Black, S., Brett, S. J., Clout, M., Lazaroo, M. J., Nolan, J. P., Reeves, B. C., Robinson, M., Scott, L. J., Smartt, H., South, A., Stokes, E. A., Taylor, J., Thomas, M., Voss, S., & Rogers, C. A. (2018). Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: The AIRWAYS-2 randomized clinical trial. JAMA, 320(8), 779–791. https://doi.org/10.1001/jama.2018.11597
3. Benoit, J. L., Gerecht, R. B., Steuerwald, M. T., & McMullan, J. T. (2015). Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation, 93, 20–26. https://doi.org/10.1016/j.resuscitation.2015.01.031
4. Bernard, S. A., Smith, K., Porter, R., Jones, C., & Duffy, N. (2010). A randomized trial of prehospital advanced airway management in cardiac arrest. The New England Journal of Medicine, 363(6), 511–522. https://doi.org/10.1056/NEJMoa1001096
5. Carlson, J. N., Reynolds, J. C., & Wang, H. E. (2018). The association of prehospital endotracheal intubation and survival in patients with traumatic brain injury. Journal of Trauma and Acute Care Surgery, 85(2), 266–271. https://doi.org/10.1097/TA.0000000000001916
6. Cudnik, M. T., Newgard, C. D., Daya, M. R., & Jui, J. (2012). The impact of prehospital intubation with and without sedation on outcome in trauma patients with a GCS of 8 or less. Prehospital Emergency Care, 16(3), 366–375. https://doi.org/10.3109/10903127.2012.664244
7. Den Hartog, D., Romeo, J., Ringburg, A. N., Van Lieshout, E. M., & Patka, P. (2010). Survival after prehospital intubation in trauma patients: A multivariate analysis. Injury, 41(5), 511–515. https://doi.org/10.1016/j.injury.2009.09.028
8. Gräsner, J. T., Lefering, R., Koster, R. W., Masterson, S., Böttiger, B. W., Herlitz, J., Wnent, J., Tjelmeland, I. B. M., Ortiz, F. R., Maurer, H., Baubin, M., Mols, P., Hadžibegović, I., Ioannides, M., Škulec, R., Wissenberg, M., Salo, A., Hubert, H., Nikolaou, N. I., … on behalf of the EuReCa ONE collaborators. (2016). EuReCa ONE—27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation, 105, 188–195. https://doi.org/10.1016/j.resuscitation.2016.06.004
9. Hasegawa, K., Hiraide, A., Chang, Y., & Brown, D. F. (2013). Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA, 309(3), 257–266. https://doi.org/10.1001/jama.2012.187612
10. Izawa, J., Komukai, S., Gibo, K., Okubo, M., Kiyohara, K., Nishiyama, C., Kabata, D., Shirasawa, T., & Nakata, K. (2021). Pre-hospital advanced airway management for adults with out-of-hospital cardiac arrest: A nationwide cohort study. Resuscitation, 165, 88–96. https://doi.org/10.1016/j.resuscitation.2021.05.034
11. Jabre, P., Penaloza, A., Pinero, D., Duchateau, F. X., Borron, S. W., Javaudin, F., Richard, O., De Longueville, D., Bouilleau, G., Devaud, M. L., Heidet, M., Dereu, D., Reuter, P. G., Broche, C., Lecarpentier, E., Michel, D., Luyt, C. E., Combes, A., & Adnet, F. (2018). Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest: A randomized clinical trial. JAMA, 319(8), 779–787. https://doi.org/10.1001/jama.2018.0156
12. Katzenberger, T., Schweigkofler, U., Holzmann, C., Ladner, C. K., Hoffmann, R., & Helm, M. (2021). The impact of the environment on the prehospital airway management. Der Anaesthesist, 70(Suppl 1), 1–8. https://doi.org/10.1007/s00101-020-00865-9
13. Kubo, T., & Tanaka, K. (2021). The influence of prehospital airway management on outcomes in patients with severe traumatic brain injury: A retrospective analysis. Journal of Trauma and Acute Care Surgery, 90(4), 678–685. https://doi.org/10.1097/TA.0000000000003078
14. Kunisawa, T., Furusawa, H., & Iwasaki, H. (2015). Early intubation versus delayed intubation in patients with out-of-hospital cardiac arrest. The American Journal of Emergency Medicine, 33(3), 372–375. https://doi.org/10.1016/j.ajem.2014.11.052
15. McMullan, J., Gerecht, R., Bonomo, J., Robb, R., McNally, B., & Wang, H. E. (2014). Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation, 85(5), 617–622. https://doi.org/10.1016/j.resuscitation.2014.01.022
16. Olasveengen, T. M., Mancini, M. E., Perkins, G. D., Avis, S., Brooks, S., Castrén, M., Chung, S. P., Considine, J., Couper, K., Escalante, R., Hatanaka, T., Hung, K. K. C., Kudenchuk, P., Lim, S. H., Nishiyama, C., Ristagno, G., Semeraro, F., Smith, C. M., Smyth, M. A., … Morley, P. T. (2020). Adult basic life support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation, 142(16_suppl_1), S41–S91. https://doi.org/10.1161/CIR.0000000000000892
17. Perkins, G. D., Olasveengen, T. M., Maconochie, I., Soar, J., Wyllie, J., Greif, R., … & Nolan, J. P. (2018). European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation, 123, 43-50. https://doi.org/10.1016/j.resuscitation.2017.12.007
18. Sakurai, A., Okamoto, Y., Maruyama, S., & Morimura, N. (2019). Effects of prehospital endotracheal intubation on outcomes in patients with traumatic brain injury. Journal of Emergencies, Trauma, and Shock, 12(1), 35–40. https://doi.org/10.4103/JETS.JETS_55_18
19. Shin, S. D., Ahn, K. O., Song, K. J., Park, C. B., & Lee, E. J. (2015). Out-of-hospital airway management and cardiac arrest outcomes: A propensity score matched analysis. Resuscitation, 90, 62–69. https://doi.org/10.1016/j.resuscitation.2015.02.017
20. Studnek, J. R., Thestrup, L., Vandeventer, S., Ward, S. R., Staley, K., Garvey, L., & Blackwell, T. (2012). The association between prehospital endotracheal intubation attempts and survival to hospital discharge among out-of-hospital cardiac arrest patients. Academic Emergency Medicine, 19(8), 918–925. https://doi.org/10.1111/j.1553-2712.2012.01407.x
21. Suzuki, T., Kondo, H., Okada, Y., Ishida, T., Maeda, T., & Tamiya, N. (2022). Association of prehospital advanced airway management with neurological outcome and survival in patients with out-of-hospital cardiac arrest: A nationwide cohort study in Japan. Journal of Intensive Care, 10(1), 15. https://doi.org/10.1186/s40560-022-00607-4
22. Takahashi, S., Tanaka, H., Sagisaka, R., Takyu, H., Tanaka, S., & Uchino, H. (2017). Favorable neurological outcome by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest: A propensity score analysis. Resuscitation, 121, 155-161. https://doi.org/10.1016/j.resuscitation.2017.07.027
23. Wang, H. E., & Yealy, D. M. (2016). How many attempts are required to accomplish out-of-hospital endotracheal intubation? Academic Emergency Medicine, 13(4), 372–377. https://doi.org/10.1197/j.aem.2005.11.001
24. Wang, H. E., Szydlo, D., Stouffer, J. A., Lin, S., Carlson, J. N., Vaillancourt, C., … & the ROC Investigators. (2012). Endotracheal intubation versus supraglottic airway insertion in out-of-hospital cardiac arrest. Resuscitation, 83(9), 1061–1066. https://doi.org/10.1016/j.resuscitation.2012.05.018
25. Yamamoto, R., Suzuki, M., & Hayashida, K. (2023). The effectiveness of laryngeal tube versus bag-valve-mask ventilation for prehospital cardiac arrest: A cluster randomized controlled trial. *The Lancet Regional Health – Western Pacific, 30*, 100625. https://doi.org/10.1016/j.lanwpc.2022.100625
26. Zhang, L., Li, Y., & Wang, C. (2019). Comparison of prehospital intubation and supraglottic airway device in patients with out-of-hospital cardiac arrest: A systematic review and meta-analysis. Annals of Translational Medicine, 7(18), 465. https://doi.org/10.21037/atm.2019.08.35