Abstract Body:
Introduction
Airway management is a crucial component of advanced life support for out-of-hospital cardiac arrest (OHCA). Supraglottic airways (SGA) are a more easily placed alternative to endotracheal intubation. Little is known about SGAs placement by emergency medical technicians (EMT). We sought to evaluate trends in SGA placement by EMTs for OHCA.
Methods
We retrospectively studied the combined 2019-2023 NEMSIS database, a US national prehospital database. We included all 9-1-1 responses for adult OHCAs with SGA insertion as the first attempted airway. We stratified encounters based on the credentials of the provider placing the SGA into EMTs and paramedics (including both paramedics and advanced EMT based on scope of practice). We evaluated the change in proportion of SGAs placed by EMTs over time using Cochran-Armitage tests. We evaluated the number of EMS agencies with EMT-placed SGAs each year. Between US Census Divisions, we evaluated regional variation in the SGA placement by EMTs. Using mixed-model logistic regression and compared to paramedics, we evaluated the association between EMT-placed SGAs and first-pass success. We adjusted the analysis for age, sex, bystander witnessed arrest, and initial shockable rhythm. We modeled EMS agency as a random intercept.
Results
We included 195,838 OHCAs that received SGA placement on their first airway attempt. 42,522 (21.7%) were placed by EMTs and 153,316 (78.3%) were placed by paramedics. The number and proportion of SGAs placed by EMTs increased over time: 3,419 (20.5%) in 2019, 7,655 (19.8%) in 2020, 9,592 (20.8%) in 2021, 10,953 (22.9%) in 2022, and 10,903 (23.4%) in 2023 (p<0.01). The number of EMS agencies with EMT-placed SGAs also increased yearly: 714 (34.5%) in 2019, 1,031 (37.6%) in 2020, 1,317(40.3%) in 2021, 1,455 (44.1%) in 2022, and 1,569 (47.8%) in 2023. The regions with the highest proportions of SGAs placed by EMTs were West North Central (38.9%), East North Central (32.3%), and Mountain (24.9%). The regions with the lowest proportion of SGAs placed by EMTs were New England (4.7%) and Middle Atlantic (2.8%). First-pass success was slightly lower for EMTs (93.6% v 94.2% for paramedics, aOR 0.94 [0.89-0.99]).
Conclusion
The proportion of SGAs placed by EMTs as well as the number and proportion of EMS agencies with EMT-placed SGAs have increased over time. First-pass success rate was slightly higher for paramedic-placed SGAs than EMT-placed SGAs.