ArticleCritical care medicine2014
The process of prehospital airway management: challenges and solutions during paramedic endotracheal intubation.
Article in Critical care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05278923 (The Impact of Soiled Airway Management on CPR Quality), which is not on this map. Cited by 27 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Impact of Soiled Airway Management on CPR Quality
Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 87 citations in OpenAlex.
- Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis.British journal of anaesthesia · 2023Pooled it
- AAGBI: Safer pre-hospital anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland.Anaesthesia · 2017Guideline
- The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis.Critical care (London, England) · 2017Pooled it
- Direct- versus video laryngoscopy during suction assisted laryngoscopy and airway decontamination (SALAD): A randomized controlled simulation study.Scientific reports · 2026Trial
- Compromised cardiopulmonary resuscitation quality due to regurgitation during endotracheal intubation: a randomised crossover manikin simulation study.BMC emergency medicine · 2022Trial
- Intubation Setting, Aspiration, and Ventilator-Associated Conditions.American journal of critical care : an official publication, American Association of Critical-Care Nurses · 2020Trial
- Novel airway device Vie Scope in several pediatric airway scenario: A randomized simulation pilot trial.Medicine · 2020Trial
- Semiprone position is superior to supine position for paediatric endotracheal intubation during massive regurgitation, a randomized crossover simulation trial.BMC anesthesiology · 2018Trial
- Prehospital airway and ventilatory management: a collaborative and narrative review.Intensive care medicine · 2026Review
- First responder airway and compression rate cluster randomized controlled trial: rational and design.Resuscitation plus · 2026Article
- Contemporary issues in pediatric prehospital airway management.Expert review of respiratory medicine · 2026Review
- Experiences of emergency care practitioners on pre-hospital rapid sequence intubation in South Africa.Health SA = SA Gesondheid · 2026Article
- The apnea interval: Ventilation interruption during tracheal intubation and its association with cardiac arrest resuscitation care and outcome.Resuscitation · 2025Article
- Safety considerations and risk mitigation strategies for ketamine use: a comprehensive review.Annals of medicine and surgery (2012) · 2025Review
- Emergency front-of-neck access in cardiac arrest: A scoping review.Resuscitation plus · 2024Article
- The reality of advanced airway management during out of hospital cardiac arrest; why did paramedics deviate from their allocated airway management strategy during the AIRWAYS-2 randomised trial?Resuscitation plus · 2023Article
- Assessment of Emergency Medical Services Personnel Compliance with Escalating Airway Algorithm Protocol.Kansas journal of medicine · 2023Article
- Medication-Facilitated Advanced Airway Management with First-Line Use of a Supraglottic Device - A One-Year Quality Assurance Review.Prehospital and disaster medicine · 2022Article
- Tracheal intubation practices and adverse events in trauma victims on arrival to trauma triage: A single centre prospective observational study.Indian journal of anaesthesia · 2022Article
- Airway status at arrival to the Emergency department among patients with life threatening emergencies.Journal of family medicine and primary care · 2020Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesEndotracheal intubation success rates in the prehospital setting are variable. Our objective was to describe the challenges encountered and corrective actions taken during the process of endotracheal intubation by paramedics.
designAnalysis of prehospital airway management using a prospective registry that was linked to an emergency medical services administrative database.
settingEmergency medical services system serving King County, Washington, 2006-2011. Paramedics in this system have the capability to administer neuromuscular blocking agents to facilitate intubation (i.e., rapid sequence intubation). PATIENTS: A total of 7,523 patients more than 12 years old in whom paramedics attempted prehospital endotracheal intubation.
interventionsNone. MEASUREMENTS AND MAIN
resultsAn intubation attempt was defined as the introduction of the laryngoscope into the patient's mouth, and the attempt concluded when the laryngoscope was removed from the mouth. Endotracheal intubation was successful on the first attempt in 77% and ultimately successful in 99% of patients (7,433 of 7,523). Paramedics used a rapid sequence intubation strategy on 54% of first attempts. Among the subset with a failed first attempt (n = 1,715), bodily fluids obstructing the laryngeal view (50%), obesity (28%), patient positioning (17%), and facial or spinal trauma (6%) were identified as challenges to intubation. A variety of adjustments were made to achieve intubation success, including upper airway suctioning (used in 43% of attempts resulting in success), patient repositioning (38%), rescue bougie use (19%), operator change (16%), and rescue rapid sequence intubation (6%). Surgical cricothyrotomy (0.4%, n = 27) and bag-valve-mask ventilation (0.8%, n = 60) were rarely performed by paramedics as final rescue airway strategies.
conclusionsAirway management in the prehospital setting has substantial challenges. Success can require a collection of adjustments that involve equipment, personnel, and medication often in a simultaneous fashion.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.