ASSOCIATION BETWEEN PREHOSPITAL AIRWAY MANAGEMENT AND 30-DAY SURVIVAL AND HYPOXIA: A 5-YEAR RETROSPECTIVE COHORT STUDY

Abstract

Prehospital airway management in respiratory failure remains controversial, particularly around the timing and choice of advanced interventions. This retrospective observational study reviewed 756 Emergency Medical Services activations in Nova Scotia, Canada, from 2015–2019 involving cardiac arrest, trauma, or medical causes. Trends in device use, outcomes, and associations with 30-day survival and hypoxia were assessed for bag-valve-mask, supraglottic airways, and endotracheal intubation. BVM use declined sharply across all cohorts, while SGA adoption increased. ETI rates were stable in cardiac arrest cases but rose modestly in trauma and medical presentations. Care times were shorter with BVM, yet advanced airway attempts carried higher hypoxia risk. Adjusted analyses found no survival differences between devices in cardiac arrest, but in trauma and medical cases BVM use was associated with reduced 30-day mortality. These findings suggest growing reliance on SGAs and potential survival advantages of less invasive airway strategies, supporting refinement of EMS protocols.