Airway management and endotracheal intubation by paramedics for cardiac arrest

The current article focuses on airway management and endotracheal intubation, by paramedics in the out-of-hospital environment. Results of a case-note review, which investigated airway management techniques used in cardiac arrest, are presented and discussed. In addition, attempts and success rates of intubation by paramedics during cardiopulmonary resuscitation (CPR) are presented and considered. Discussions around the literature base and newer evidence are blended and summarised, making recommendations for further study.

Paramedics are trained in airway management, including in the skill of endotracheal intubation (ETI) in practice. Guidance is available to support paramedics regarding when and how ETI should be performed, as well as local standard operating procedures (SoPs) in deploying the skill (Brown et al, 2016). Airway management takes a step-wise approach (Figure 1) and incorporates the use of supraglottic airway devices (SGAs) such as laryngeal mask airways (LMAs) and iGels. There have been several studies comparing the use of SGAs to endotracheal tubes (ETTs), including the large Airways-2 trial (Taylor et al, 2016), which has recently finished collecting data.