Prehospital airway and ventilatory management: a collaborative and narrative review
Authors' conclusion
Specific contexts require tailored adaptations: altitude physiology in helicopter transport, obesity-specific positioning, cervical spine precautions in neurological injury, comfort-focused strategies in palliative patients, and proactive stabilization before prolonged transport.
Study context
- Population
- Patients requiring prehospital airway and ventilatory management
Methodological detailscollaborative
- Collaborative
Main finding
As reported in the abstract
- Tracheal intubation remains the definitive airway strategy when performed for appropriate indications by adequately trained providers
- Indications: major trauma, TBI, OHCA, comatose patients; role in comatose poisoned patients increasingly questioned
- Physiology optimization before intubation (preoxygenation with non-invasive positive pressure ventilation, bag-valve-mask ventilation between induction and laryngoscopy, careful sedative selection) is a critical determinant of outcome
- Failed intubation: structured escalation (videolaryngoscopy, supraglottic airway devices, emergency front-of-neck access) must be rehearsed and immediately available
- In OHCA, supraglottic airways are a valid primary alternative with equivalent neurological survival and faster placement
- NIV (primarily CPAP and BiPAP) reduces intubation rates and mortality in acute cardiogenic pulmonary edema and COPD exacerbations
- High-flow nasal oxygen: strong in-hospital evidence, but prehospital data extremely limited and logistics restrict routine use
- Non-invasive support must never delay intubation when clinical deterioration demands it
Original publication
Prehospital airway and ventilatory management: a collaborative and narrative review. Intensive Care Med. Published 2 July 2026. doi:10.
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