Abstract 234: Longitudinal Trends in Prehospital Advanced Airway Management in the United States

Background: While endotracheal intubation (ETI) is the most common prehospital advanced airway management technique in the United States (US), observations from clinical trials and the COVID-19 pandemic have motivated the broader use of supraglottic airways (SGA). The current national patterns of prehospital airway practices are unknown. We sought to describe longitudinal trends in Emergency Medical Services (EMS) advanced airway management in the US.

Methods: We analyzed 2011-2021 data from ESO, a data set of US prehospital electronic health records. We identified all 911 events with attempted advanced airway management, determining the annual percentage receiving ETI and/or SGA attempts. We determined temporal trends using mixed effects regression. We stratified the analyses by condition (cardiac arrest, trauma, medical non-arrest) and age (adult vs. children [<18y]).

Results: During the study period 355,532 patients underwent prehospital advanced airway management (annual incidence 9.0-10.0 per 1,000 911 events). Annual patients with SGA attempts increased almost three-fold (20.8% to 53.2%; p-trend<0.001), while annual patients with ETI attempts decreased (90.0% to 60.7%, p-trend<0.001). (Figure) Trends for cardiac arrest (SGA increased from 25.1% to 60.6%; ETI decreased from 87.3% to 54.7%) and trauma (SGA increased from 17.2% to 40.7%; ETI decreased from 90.5% to 71.8%) were similar. Advanced airway management in medical non-arrest patients remained stable (SGA 15.7% to 20.0%, p-trend=0.26; ETI 93.3% to 87.5%, p-trend=0.85). In children SGA attempts increased five-fold (11.2% to 50.9%, p-trend<0.001) while ETI attempts decreased (89.7% to 60.6%, p-trend<0.001).

Conclusion: US prehospital advanced airway management practices have shifted, with marked increases in SGA and decreases in ETI attempts. These observations have critical implications for EMS care, training and system planning.