Comparative Study of Airway Management Techniques in Pre-Hospital Emergency Care

Abstract

Pre-hospital airway management in emergency care has evolved significantly, shifting from a rigid emphasis on endotracheal intubation (ETI) as the definitive standard to a nuanced, context-dependent approach prioritizing effective oxygenation, ventilation, minimal interruption of chest compressions, and overall perfusion. This comparative review examines the technical foundations, mechanical characteristics, and clinical outcomes of basic airway maneuvers (bag-valve-mask [BVM] ventilation), supraglottic airway (SGA) devices (including i-gel and King LT), and advanced techniques such as ETI with direct or video laryngoscopy. In out-of-hospital cardiac arrest (OHCA), landmark trials like AIRWAYS-2 and PART, alongside meta-analyses, demonstrate comparable or contextually superior outcomes with SGAs in terms of first-pass success, reduced hands-off time, and survival metrics (higher 72-hour survival with laryngeal tube in PART, no difference in favorable neurological outcomes in AIRWAYS-2). However, ETI may offer advantages in specific subgroups, such as witnessed non-shockable rhythms. In trauma and traumatic brain injury, ETI remains frequently utilized for precise control, though overall mortality shows no significant difference compared to extraglottic alternatives when performed by experienced providers. Pediatric scenarios highlight higher risks with advanced airways, favoring BVM as the initial strategy pending ongoing trials like Pedi-PART. Current 2025 AHA and ERC guidelines advocate a stepwise, provider-skill-based selection without universal superiority of any single method, mandating waveform capnography and emphasizing perfusion-centric resuscitation. Emerging technologies, including AI-assisted video laryngoscopy, signal future refinements. Overall, evidence supports SGAs as a robust primary option in most adult OHCA cases, with ETI reserved for scenarios requiring definitive airway protection.