Airway Management Analysis in the Rescue Environment of the Emergency Service Zug: A Retrospective Real-World Evaluation

Background Airway management is critical in prehospital care. This study quantified first pass success (FPS) for endotracheal intubation (ETI) in a Swiss emergency medical service (EMS) and identified factors associated with success. Methods All adult (≥ 18 year) ETI attempts documented in the EMS database between 1 January 2021 until 31 December 2024 were reviewed. Devices [direct laryngoscopy, standard-geometry videolaryngoscope (VL), hyperangulated VL], adjuncts [bougie, stylet], operators [critical-care paramedic (CCP), emergency physician (EP)] and setting were analyzed. The primary outcome was FPS; predictors were evaluated with univariate and multivariable logistic regression. Results ETI was attempted in 270 patients (mean age 67.9 ± 16.4 year; 64.8% male); 55.6% occurred during cardiopulmonary resuscitation. Overall FPS was 92.6% (250/270). Bougie use achieved 100% (49/49) FPS versus 91.0% (201/221) with a stylet (p = 0.03). Device-specific FPS was 94.3% (33/250, direct), 94.0% (173/250, standard-geometry VL) and 86.3% (44/250, D-BLADE VL). FPS was significantly associated with D-BLADE VL use in patients with an anticipated difficult intubation (OR 0.29, 95% CI 0.10 to 0.83). CCP showed higher odds for FPS for CCP compared to EP (OR 3.61, 95% CI 1.14 to 11.45). Conclusions Bougie-assisted laryngoscopy was significantly associated with first pass success rates. When a difficult airway was anticipated, the hyperangulated D-BLADE videolaryngoscope showed higher odds for first pass success. Critical-care paramedics achieved first pass success rates comparable to those of emergency physicians. Trial registration Clinicaltrials.gov: NCT06653166 (19 October 2024)