New Evidence-Based Guidelines for Prehospital Airway Management

Airway management is the foundation of prehospital emergency care. Emergency medical services (EMS) practice now includes a range of airway techniques. However, evidence is still lacking as to which of these airway management approaches under which circumstances have the best outcomes.

To address this issue, the National Association of State EMS Officials (NASEMSO) has been leading a project that recently published an “Evidence-Based Guideline for Prehospital Airway Management.”

Evidence-based guidelines (EBGs) are created for many reasons, but one of the most critical is that they make it easier for EMS medical directors, leaders and clinicians to provide the most appropriate care — even if they don’t have the time or expertise to read, interpret and synthesize the available evidence.

The EBG for prehospital airway management offers EMS providers an opportunity to review and update their airway management strategies.

The EBG makes 22 recommendations on the use of 3 airway management approaches: bag-valve mask, supraglottic airway and endotracheal intubation. The 3 approaches were assessed for 2 populations (adults and children) and for 3 types of emergency medical events (cardiac arrest, medical emergencies and trauma). Additional recommendations address the use of video laryngoscopy and drug-assisted airway management.

Appendix A of the EBG operationalizes the recommendations into a set of good practice statements.

The evidence used to develop these recommendations comes from a systematic review by the Agency for Healthcare Research and Quality (AHRQ) in 2021. The systematic review assessed comparative benefits and harms of these 3 airway management approaches in various circumstances, based on findings from 99 studies involving 630,397 patients.

This publication is part of a larger project led by NASEMSO through a cooperative agreement with the National Highway Traffic Safety Administration’s Office of EMS (NHTSA OEMS), in partnership with the American College of Emergency Physicians^®, the National EMS Quality Alliance and the National Registry of EMTs^®.

In accordance with the NHTSA OEMS’ National Prehospital Evidence-Based Guideline Model Process, this EBG will be used as a basis for a model protocol for prehospital airway management. The project outcomes will also include associated quality measures and educational materials to help distribute the EBG and model protocol to EMS clinicians and EMS medical directors.

The “Evidence-Based Guideline for Prehospital Airway Management”; the methodology for its development; an article summarizing the EBG, its significance, and future direction; and the 2021 systematic review were published in the journal Prehospital Emergency Care.

Learn more about the larger Prehospital Airway Management Evidence Based Guideline project on NASEMSO’s website. Access all EBGs and related documents on EMS.gov.

(Sources: Prehospital Emergency Care, NHTSA OEMS, AHRQ)