The impact of airway assistants on prehospital endotracheal intubations – a subgroup analysis of data from anaesthesiologist staffed helicopter critical care teams

Background: Advanced airway management in the prehospital environment is a technically demanding and high-stakes procedure requiring effective team collaboration. While operator skill is often emphasized, few studies have examined whether an airway assistant’s professional background influences intubation outcomes. This subgroup analysis of prehospital advanced airway management data aimed to evaluate whether the airway assistant profession affects first-pass success and complication rates during prehospital drug-assisted endotracheal intubation performed by anaesthesiologist-staffed Scandinavian helicopter emergency medical services. Methods: This retrospective subgroup analysis included 422 patients from 12 helicopter emergency medical services across Denmark, Norway, and Sweden between March 2020 and September 2021. The primary outcome was the first-pass success rate, which was defined as successful endotracheal intubation on the first attempt. The main exposure was the airway assistant profession (anaesthetist vs. non-anaesthetist). The secondary outcomes included intubation-related complications. Binary logistic regression was used to assess associations between the assistant profession and first-pass success or complication rates, adjusting for predefined covariates. Results: Among the 422 drug-assisted intubations, 143 (33.9%) involved anaesthetist assistants and 279 (66.1%) involved non-anaesthetists. First-pass success was similar between groups (88.1% vs. 87.8%, p = 1.000), with an adjusted odds ratio of 1.25 (95% CI 0.65–2.48). The overall complication rate was 10.7%, with no significant difference between the groups (8.4% vs. 11.8%, p = 0.32; adjusted odds ratio 1.79, 95% CI 0.66–5.39). Hypoxia was more common in the anaesthetist-assisted group (7.7% vs. 3.9%, p = 0.00115), but this may reflect case-mix differences. No other significant differences were found in procedural performance or outcomes. Conclusions: In this large, multicentre observational study, the airway assistant profession was not independently associated with first-pass success or complication rates. These findings suggest that in mature helicopter emergency medical services with experienced anaesthesiologists and standardized protocols, team functioning and structured processes may outweigh individual assistant backgrounds in determining airway management success. Trial registration (clinical trial number): NCT04206566 (first record registered 2019-12-18)