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 years) ETI attempts documented in the EMS database between 1 January 2021 and 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% intubations 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% (33/35, direct laryngoscopy), 94.0% (173/184, standard-geometry VL) and 86.3% (44/51, D-BLADE VL). FPS was significantly associated with D-BLADE VL use in patients with an anticipated difficult intubation (89,7% FPS, p < 0.001). 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 higher 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: Clinical Trials.gov: NCT06653166 (19 October 2024).