24.Issue 12 december 25 - INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES

Volume : 12, Issue : 12, December- 2025

Title:

FIRST-PASS SUCCESS VS. TIME-TO-INTUBATION: A SYSTEMATIC REVIEW OF OPTIMAL AIRWAY MANAGEMENT METRICS IN PREHOSPITAL TRAUMA

Authors :

Meshari Ahmed Alsehumai, Saud Qasem Alqarni, Fahad Mabruk Altayyari, Mohammed Ahmed Alzahrani, Hassan Mohammed Ali Aseri, Sultan Sttan Alrshedi, Falah Hamdan Alhomidani, Khaled Mohammed Al-Hawas, Raed Mohsen Alsehani, Turki Mohammed Alotaibi

Abstract :

Securing a definitive airway is a critical intervention in prehospital trauma resuscitation. First-Pass Success (FPS) has become the dominant quality metric, though the physiological imperative to minimize Time-to-Intubation (TTI) is also significant. A systematic evaluation is required to determine which metric, or combination thereof, is most associated with improved patient outcomes. This systematic review aimed to synthesize evidence comparing FPS and TTI as predictors of morbidity and mortality in prehospital trauma airway management. A comprehensive search of five databases (PubMed/MEDLINE, Embase, Scopus, CENTRAL, Web of Science) from inception to December 2023 was conducted following PRISMA 2020 guidelines (PROSPERO: CRD42024512345). Studies reporting FPS and/or TTI in prehospital trauma populations were included. Data on study characteristics, metrics, and patient outcomes were extracted, and risk of bias was assessed using the Newcastle-Ottawa Scale. Sixteen observational studies (≈65,000 intubation attempts) were included. FPS rates ranged from 76.3% to 94.0% (weighted mean 87.1%). While multiple intubation attempts were strongly linked to immediate complications (e.g., hypoxemia, cardiac arrest), FPS showed no independent association with 30-day mortality in one high-quality registry study. TTI was inconsistently defined and rarely reported; no study established a correlation between TTI and patient outcomes. Limited data suggest that protocols improving FPS (e.g., using videolaryngoscopy) do not increase TTI and may enhance procedural efficiency. FPS is a vital process metric for preventing immediate harm, but its value as a standalone predictor of survival is nuanced. TTI remains an under-measured variable of probable physiological importance. A composite endpoint, integrating both success and speed (e.g., FPS within a defined TTI threshold), is recommended for future research, quality assurance, and clinical protocol design to fully assess and optimize prehospital trauma airway management.
Keywords: Prehospital Trauma; Airway Management; First-Pass Success; Time-to-Intubation; Systematic Review.

Cite This Article:

Please cite this article in press Meshari Ahmed Alsehumai et al., First-pass success vs. Time-to-intubation: A Systematic Review Of Optimal Airway Management Metrics In Prehospital Trauma, Indo Am. J. P. Sci, 2025; 12(12).

Number of Downloads : 10

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