High ​performance prehospital ​airway ​management: Raising the ​bar with ​education, ​rapid ​sequence ​intubation, ​suction ​assisted ​laryngoscopy ​airway ​decontamination, ​video ​laryngoscopy, and ​skills ​proficiency

Our prehospital EMS system has focused on prehospital airway management, with the advent of rapid sequence intubation and video laryngoscopy. Through education and continuous quality improvement intubation success rates using the “Glidescope Go” device have continued to improve and remain the primary tool for airway management in our system. Our objective was to demonstrate how education, rapid sequence intubation (RSI), suction-assisted laryngoscopy airway decontamination (SALAD), video laryngoscopy (VL), and skills proficiency can be used together to systemically improve paramedic airway management success to nearly 100%. Study Design: Retrospective cohort of airway management procedures performed by paramedics on prehospital patients. Setting: 10 New Jersey paramedic units. Population: Patients that had airway management completed by paramedics from 1/1/2020 to 12/31/2021. Data Analysis: We analyzed the use of RSI, first pass intubation success rates, overall intubation success rates, supraglottic airway use (i-gel®), and overall airway management success rates. Historical annual first pass success rates are also included for context. The database contained 990 patients. Of these patients the first pass intubation success rates were 92.7% over the study period. The overall intubation success rates were 98%, and intubation success rates using RSI were 99%. Backup supraglottic airways were placed in remaining cases, bringing overall airway management success rates to 99.5%. We found that paramedic intubation success rates using SALAD and VL were at 98%. A prehospital airway management strategy focused on education and skills proficiency can minimize the risk of this important skill and has potential to improve patient outcomes.