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Resuscitation. 2019 Nov 20;146:43-49. doi: 10.1016/j.resuscitation.2019.11.006. [Epub ahead of print]

Advanced airway management success rates in a national cohort of emergency medical services agencies.

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McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Williamson County Emergency Medical Services, Georgetown, TX, United States; Texas A&M Health Science Center, Temple, TX, United States.
ESO Solutions, Inc., Austin, TX, United States.
Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.
Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States. Electronic address:



Despite its important role in care of the critically ill, there have been few large-scale descriptions of the epidemiology of Emergency Medical Services (EMS) advanced airway management (AAM) and the variations in care with different patient subsets. We sought to characterize AAM performance in a national cohort of EMS agencies.


We used data from ESO Solutions, Inc., a national EMS electronic health record system. We analyzed EMS emergency patient encounters during 2011-2015 with attempted AAM. We categorized AAM techniques as conventional endotracheal intubation (cETI), neuromuscular blockade assisted intubation (NMBA-ETI), supraglottic airway (SGA), and cricothyroidotomy (needle and open). Determination of successful AAM was based on EMS provider report. We analyzed the data using descriptive statistics, determining the incidence and clinical characteristics of AAM cases. We determined success rates for each AAM technique, stratifying by the subsets cardiac arrest, medical non-arrest, trauma, and pediatrics (age ≤12 years).


AAM occurred in 57,209 patients. Overall AAM success was 89.1% (95% CI: 88.8-89.3%) across all patients and techniques. Intubation success rates varied by technique; cETI (n = 38,004; 76.9%, 95% CI: 76.5-77.3%), NMBA-ETI (n = 6768; 89.7%, 88.9-90.4%). SGAs were used both for initial (n = 9461, 90.1% success, 95% CI: 89.5-90.7%) and rescue (n = 5994, 87.3% success, 95% CI: 86.4-88.1%) AAM. Cricothyroidotomy success rates were low: initial cricothyroidotomy (n = 202, 17.3% success, 95% CI: 12.4-23.3%), rescue cricothyroidotomy (n = 85, 52.9% success, 95% CI: 41.8-88%). AAM success rates varied by patient subset: cardiac arrest (n = 35,782; 91.7%, 95% CI: 91.4-92.0), medical non-arrest (n = 17,086; 84.7%, 84.2-85.2%); trauma (n = 4341; 84.3%, 83.1-85.3%); pediatric (n = 1223; 73.7%, 71.2-76.2%).


AAM success rates varied by airway technique and patient subset. In this national cohort, these results offer perspectives of EMS AAM practices.


Airway management; Cardiac arrest; Emergency medical services; Intubation (intratracheal); Paramedics; Pediatrics; Rapid sequence intubation; Trauma

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