Supraglottic airway use in emergency medical service events rises in 2022 vs. 2011
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Key takeaways:
- In four clinical conditions, the proportion of intubation attempts in emergency events was lower in 2022 vs. 2011.
- Researchers found more supraglottic airway attempts in 2022 vs. 2011.
Between 2011 and 2022, supraglottic airway use in cardiac arrest and pediatric emergency medical service events went up, whereas endotracheal intubation use went down, according to results published in JAMA Network Open.
“For emergency medical service (EMS) practitioners and medical directors, this is a hint of active change in clinical practice,” Henry E. Wang, MD, MS, professor and vice chair for research in the department of emergency medicine and deputy director of The Ohio State University Clinical and Translational Science Institute, told Healio. “Those considering the switch from intubation to supraglottic airways (SGA) can be assured that this is consistent with national trends.
“Hospital providers must become familiar with paramedic SGA devices and understand how they should be handled when a patient transitions to the hospital setting,” Wang continued.
In a national retrospective cross-sectional study, Wang and colleagues assessed 444,041 EMS activations (mean age, 60.6 years; 61.5% men) that involved an advanced airway management attempt to find out how usage of endotracheal intubation (ETI) and SGA in cardiac arrest (343,312 events), nonarrest medical (79,358 events), nonarrest trauma (21,371 events) and pediatrics has changed from 2011 to 2022.
“For 4 decades, paramedics in the U.S. have performed ETI as the standard of resuscitation care,” Wang told Healio. “Over the last 10 years, some medical directors have suggested the use of SGA because they are easy to learn, easier to insert than an endotracheal tube, have fewer adverse effects and seem to ventilate as well as ET tubes.”
An ETI attempt was found in 305,584 EMS activations (68.8%), whereas an SGA attempt was found in 200,437 EMS activations (45.1%), according to the study.
In 2011, 87.3% of EMS events for cardiac arrest had an ETI attempt, which was higher than the 25.1% of EMS events for this condition with an SGA attempt. However, in 2022, researchers reported that the opposite was found, with a higher proportion of EMS events with SGA vs. ETI attempts (61% vs. 55.1%).
“Our study highlights a remarkable observation — that the percentage of cardiac arrests receiving paramedic SGA now exceeds the percentage receiving intubation,” Wang told Healio.
The trend observed above was comparable to what researchers found when evaluating EMS events for pediatrics. In 2011, 97.3% of EMS events in this cohort had an ETI attempt, but this proportion dropped to 68.2% in 2022. Switching to SGA attempts, only 6% of EMS events in 2011 attempted this type of advanced airway management, but this grew to 45.9% in 2022.
Looking at attempts in nonarrest medical situations, the study showed a reduced proportion of ETI attempts in EMS events from 2011 (93.3%) to 2022 (85.1%). In contrast, there was an elevated proportion of SGA attempts between the two years studied (15.7% to 22.6%).
This pattern was also seen in nonarrest trauma situations, with a lower proportion of ETI attempts in 2022 vs. 2011 (84.3% vs. 93.7%) and a higher proportion of SGA attempts in 2022 vs. 2011 (26.2% vs. 13.8%), according to the study.
When asked why ETI is used less and SGA is used more now, Wang said two forces may have had an influence.
“First, clinical trials such as the PART and Airways-2 trials showed that SGAs were viable alternatives to intubation in adult cardiac arrest,” Wang told Healio. “These findings motivated EMS medical directors to implement ways to accelerate airway management while minimizing impact on CPR chest compressions.
“Secondly, the COVID-19 pandemic triggered EMS to move to methods that minimize pathogen exposure,” Wang continued. “Prehospital SGA insertion was widely used instead of intubation during the COVID-19 pandemic to minimize disease exposure.”
Comparing the two advanced airway management methods, Wang told Healio there are more cons linked to ETI usage.
“Intubation is difficult and prone to adverse effects such as unrecognized tube misplacement,” Wang said. “Intubation also requires considerable training, including practice on human patients in the operating room.
“SGA technique is much easier and requires less training,” he continued. “Paramedics can insert an SGA faster and earlier than an ET tube.”
Looking ahead, studies of prehospital airway management should include SGAs, Wang said.
“SGAs are here to stay,” Wang told Healio.