Secular Trends in Airway Management of Out-of-Hospital Cardiac Arrest in the National EMS Information System (NEMSIS) Dataset

IntroductionAdvanced airway management is essential in resuscitation from out-of-hospital cardiac arrest (OHCA). No longitudinal national studies have described longitudinal trends in airway device choice. We sought to evaluate secular trends of OHCA endotracheal intubation (ETI) and supraglottic airway (SGA) in the United States (US). MethodsWe evaluated ETI and SGA use for 2013-2022 in adult OHCA in the US using the National EMS Information System (NEMSIS) database. We identified OHCA events (CPR performed or defibrillation) and evaluated the proportions of ETI and SGA used during OHCA. We repeated the results stratified by urbanicity. We used descriptive statistics to describe incidence prevalence with nonparametric trend testing for proportional changes over time and a two-sample stochastic rank sum test for equivalence to evaluate airway use differences by urbanicity. ResultsDuring the study period, we observed 320,154,097 adult 9-1-1 events. Of 3,118,703 OHCA, there were 699,568 and 337,458 cases with reported ETI and SGA attempts. The dominant airway choice was ETI, though the trend of ETI choice decreased as SGA increased over time (p-trend <0.05). From 2013 to 2022, SGA use increased in urban settings while rural and suburban remained stable (urban 27% to 39%*; suburban 31% to 29%; rural 28% to 29%, respectively, *p<0.05). ConclusionOver ten years, rates of advanced airway use have increased, with ETI remaining the predominant airway for adults in OHCA. Interestingly, ETI choice decreased as SGA increased over the study period. SGA use distinctly differed in urban settings, increasing concerns for disparities in care provision among communities. With the increased use of SGA over time, further evaluation of patient outcomes is required in datasets with robust linkage to Utstein variables.