Advanced airway management in out-of-hospital cardiac arrest: a service evaluation from a regional English ambulance service.
British paramedic journal · 2026-06-01 · Observational study
Abstract
INTRODUCTION: Following national changes to airway management practice in out-of-hospital cardiac arrest (OHCA), endotracheal intubation (ETI) is no longer a core paramedic skill in many English ambulance services. This service evaluation assessed airway practice and success rates in OHCA, focusing on supraglottic airways (SGAs) and ETI, following the restriction of ETI to advanced airways clinicians (AACs) within a regional ambulance service. METHODS: This retrospective observational service evaluation included all OHCA incidents between April and September 2024 where resuscitation was attempted. Data were extracted from structured and free-text fields within the ambulance service's OHCA registry. Variables analysed included the airway device used, ETI success and the number of attempts prior to success or subsequent change to an alternative airway strategy. SGA outcomes and basic demographic and survival data were also analysed. A sub-analysis explored documented SGA difficulties and associated themes. RESULTS: SGAs were used in 85.8% of incidents, with an overall success rate of 84.3%. Success was higher in paramedic-led cases (91.4%) compared to those where AACs attended (77.8%). ETI was performed in 37.1% of AAC-attended incidents, with overall success of 97.7% and first-pass success of 92.6%. ETI success was higher when following return of spontaneous circulation compared to intra-arrest intubation (99.0% versus 96.8%, respectively). In 8.6% of incidents, SGAs were initially documented as successful but subsequently replaced. SGA failure was commonly associated with airway contamination requiring suction (67.3%). ETI use was more frequent in younger patients and those surviving to 30 days, though findings may reflect service evaluation limitations rather than outcome-driven benefit. CONCLUSION: SGAs remain an effective first-line airway device in OHCA, particularly for frontline clinicians, although success may be reduced in contaminated airways. ETI first-pass and overall success rates were high when delivered within an AAC model, characterised by robust clinical governance and regular clinical exposure.
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Tags
Critical care & advanced paramedics · Implementation · Endotracheal intubation · Mortality & survival · Paramedics & EMTs · Suction · Supraglottic airway
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