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Airway & ventilation research
26 recent papers on airway & ventilation in paramedic and prehospital care, newest first. Each has a plain-English summary, the study design, the main finding and caveat, and what it means for Australian practice.
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Transport ventilation during CPR feasible in pilot
A Thai exploratory pilot compared transport mechanical ventilation (HAMILTON-T1, volume-controlled) with bag-valve ventilation during CPR in adult OHCA and found no significant differences in PCO2, pH, pO2, sustained ROSC or 28-day survival, with mechanical ventilation operationally feasible.
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Real-time feedback tidies BVM ventilation in arrest
A Paris before-and-after study of 163 arrests found real-time feedback during bag-valve-mask ventilation improved insufflated-volume adherence (68% vs 42% of breaths in the 400–600 mL range) and cut leak volume by 12%, although expired tidal volumes were unchanged.
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Airway strategy and survival in Polish HEMS
A retrospective analysis of Poland's national physician-staffed HEMS registry tested airway strategies in 8,980 intubated adults against survival to hospital handover — HEMS-performed intubation was most common (49.8%), and in non-traumatic cardiac arrest a sequential supraglottic-airway-then-intubation strategy showed no significant difference from HEMS-performed intubation, while some other strategies carried higher unadjusted odds of not being alive at handover.
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Mechanical vs manual BVM in adult CPR
Systematic review and Bayesian meta-analysis comparing mechanical versus manual bag-valve ventilation during adult CPR — abstract not yet available, so no pooled findings to report yet.
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Video laryngoscopy edges out direct in kids
A systematic review and meta-analysis of 18 studies (17 observational, 1 RCT) found video laryngoscopy for paediatric emergency intubation was associated with higher first-pass success (RR 1.11) and fewer severe adverse events (RR 0.76), on very low certainty evidence.
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Prehospital RSI: what makes it hard
Qualitative focus-group study of 39 South African emergency care practitioners found pre-hospital RSI is hampered by system-driven administrative demands, resource and workforce constraints, and communication gaps affecting clinical decision-making.
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NRB + nasal cannula inferior to flush-rate preoxygenation
Healthy-volunteer crossover study — NRB plus nasal cannula at 15–25 L/min each produced expired oxygen of 68–75% versus 85% for flush-rate NRB, so the portable-cylinder workaround is inferior when supply allows flush rate.
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Feedback improves neonatal face mask ventilation
Prospective simulation study in neonatology fellows testing low-dose, high-frequency face mask ventilation practice with real-time respiratory function monitor feedback across T-piece, self-inflating and flow-inflating bags — feedback lifted tidal volumes in target range from 62.3% to 80.3% and cut mask leak on every device, while extra sessions without feedback added little.
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SGA vs intubation in OHCA: ROSC lower with SGA
Systematic review and meta-analysis comparing supraglottic airway devices with endotracheal intubation in out-of-hospital cardiac arrest. Abstract not yet available (ahead-of-print).
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VAPOX preoxygenation in ED intubation
Australian retrospective cohort of 116 patients intubated with ventilator-assisted preoxygenation (VAPOX) in two EDs — 78% achieved first-pass success without hypoxaemia, but half had at least one complication and 36% became hypotensive after intubation
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Ventilation feedback devices inaccurate during CPR
Simulation cross-over study of two commercial ventilation feedback devices used during continuous compressions with asynchronous ventilations — both were clinically inaccurate, one displaying 111 breaths/min when the true rate was 12 and underestimating tidal volume by up to 440 mL in reversed airflow.
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Prehospital cricothyroidotomy: rare but often successful
Nationwide Danish cohort of all 71 prehospital emergency cricothyroidotomies over 2016–2023 — overall procedural success 87.3% (83.3% in OHCA), aspiration and oropharyngeal bleeding the commonest indications, but the procedure was rare (0.12% of 39,885 OHCAs) and OHCA outcomes were poor (ROSC 25%, 30-day survival 4.5%, 1-year survival 2.3%).
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Paralysing post-ROSC patients prehospital
UK cohort of advanced paramedics in critical care giving neuromuscular blockade to post-ROSC patients poorly tolerating the tube — 99 patients over a year, all PGD indications met, with no adverse physiological trends in sats, end-tidal CO2, MAP or heart rate.
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ED intubation success high with videolaryngoscopy
Retrospective study of 1,250 ED intubations showed 93.8% first-pass success with videolaryngoscopy as primary technique, with hypotension and desaturation as most common adverse events.
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Capnometry with prehospital intubation cuts mortality
Nationwide registry study examining capnometry use during prehospital intubation and its association with 30-day mortality.
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Predictors of hyperoxaemia after prehospital oxygen
Prospective cohort of 245 patients found 24.5% had hyperoxemia (PaO₂ >120 mmHg), with intubation (OR 38.89) and transport duration ≥24 min (OR 13.74) as independent predictors.
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High adverse event rate after prehospital RSI
Investigates the prevalence of adverse events following prehospital airway management using neuromuscular blockade
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Mechanical vs manual ventilation in CPR equal
This systematic review of 13 articles (six RCTs, seven non-randomised studies) found very low to low certainty evidence showing no significant difference in ROSC between volume-controlled mechanical ventilation and manual ventilation during CPR.
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Miller vs Macintosh blade in paediatric intubation
In this cohort of young children intubated in the ED, Macintosh blade use was associated with higher FPS and fewer hypoxic events compared with Miller blade.
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Awake intubation by emergency physicians feasible
In this preliminary single-center study, emergency physicians performed awake intubation with relatively high incidence, high overall success, and low rates of major adverse events.
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Hypopharyngeal perforation after King laryngeal tube
Hypopharyngeal perforation is a rare but serious complication of prehospital King laryngeal tube placement.
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Bolus-only prehospital RSI maintenance highly variable
Retrospective study showing that prehospital anaesthesia maintenance using intermittent boluses results in high variability of cumulative sedative/analgesic doses, potentially risking sub-therapeutic plasma levels.
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AI in prehospital airway care still experimental
They reviewed AI applications in prehospital airway management and found most tools remain experimental, with limited integration into clinical workflows despite promising capabilities for difficult airway prediction and real-time guidance.
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Alfen blind intubation device works on manikins
Manikin study with 157 intubation attempts achieved >98% success rate with the novel blind intubation device across operators of varying experience.
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Italian HEMS airway equipment varies, training patchy
This national survey documented airway management skills and device availability across Italian HEMS services, showing variability in advanced airway training and device adoption.
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Automated ventilation wins in helicopter short-haul
Simulation study comparing bag-valve ventilation with automated ventilation during short-haul helicopter rescue using an i-gel — automated ventilation achieved target minute ventilation more consistently, caused less airway movement, and avoided disconnects.