Issue
Date Log
Copyright (c) 2025 Sultan Yahya Ali Alqahtani, Nadia Helal Almutairi, Sultan Mansour Matar Alanezi, Rana Ali Al-Suwais, Fatimah Jaber Ali Majrashy, Nadia Helal Almutairi, Faisal bin Ayidh Alshahrani, Ahmed Ali M Abu Shaeqa, Malek Awadh Allah Alsulami, Alhassan Mohammed Alwadai, Nawaf Oudah Alsenani, Majed Mikhdhar Alamri, Musaad Eid Saeed Al-Dosari
This work is licensed under a Creative Commons Attribution 4.0 International License.
Airway management success rate in prehospital EMS and hospital emergency departments- An Updated Review for Nursing, Emergency Professionals, and Dentists
Corresponding Author(s) : Sultan Yahya Ali Alqahtani
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Airway management is a cornerstone of emergency and critical care practice, requiring deep knowledge of airway anatomy, physiology, device selection, and procedural strategies. Differences between adult and pediatric airways, along with disease-related anatomical variations, significantly influence intubation success and complication rates.
Aim: This review aims to update healthcare providers—including nurses, emergency personnel, and dentists—on modern airway management principles, devices, techniques, and complications across prehospital and hospital settings.
Methods: The article synthesizes evidence from current airway management literature, addressing anatomy, indications, contraindications, procedural steps, pharmacologic preparation, and team dynamics involved in effective airway management.
Results: Key findings reveal critical anatomical differences between pediatric and adult airways, influencing device choice and positioning techniques. Video laryngoscopy and cuffed pediatric tubes improve visualization and ventilation control. Preoxygenation, rapid-sequence induction, appropriate drug selection, and structured intubation steps enhance safety and first-pass success. Complications include esophageal intubation, airway trauma, respiratory failure, pneumothorax exacerbation, and right-mainstem intubation risk. A multidisciplinary team with coordinated roles is essential for reducing complications and improving outcomes.
Conclusion: Effective airway management requires comprehensive anatomical knowledge, structured techniques, advanced visualization tools, proper device selection, and coordinated team-based care. Recognition of difficult airway predictors and adherence to evidence-based practices significantly improve patient safety and clinical outcomes.
Keywords
Download Citation
Endnote/Zotero/Mendeley (RIS)BibTeX
- Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. Int J Crit Illn Inj Sci. 2014 Jan;4(1):65-70.
- Griscom NT, Wohl ME. Dimensions of the growing trachea related to age and gender. AJR Am J Roentgenol. 1986 Feb;146(2):233-7.
- Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010 Oct;113(4):819-24.
- Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr. 2004 Mar;144(3):333-7.
- Piepho T, Kriege M, Byhahn C, Cavus E, Dörges V, Ilper H, Kehl F, Loop T, Raymondos K, Sujatta S, Timmermann A, Zwißler B, Noppens R. German guidelines for airway management 2023. Anaesthesiologie. 2024 May 16;
- Long B, Gottlieb M. Emergency medicine updates: Endotracheal intubation. Am J Emerg Med. 2024 Nov;85:108-116.
- Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: dispelling myths and establishing the facts. Emerg Med J. 2005 Jun;22(6):394-6.
- Shen CM, Soong WJ, Jeng MJ, Lee YS, Cheng CY, Sun J, Hwang B. Nasopharyngeal tract length measurement in infants. Acta Paediatr Taiwan. 2002 Mar-Apr;43(2):82-5.
- Davis DP, Koprowicz KM, Newgard CD, Daya M, Bulger EM, Stiell I, Nichol G, Stephens S, Dreyer J, Minei J, Kerby JD. The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale Scores of 8 or less. Prehosp Emerg Care. 2011 Apr-Jun;15(2):184-92.
- Daugherty RJ, Nadkarni V, Brenn BR. Endotracheal tube size estimation for children with pathological short stature. Pediatr Emerg Care. 2006 Nov;22(11):710-7.
- Mosier JM, Stolz U, Chiu S, Sakles JC. Difficult airway management in the emergency department: GlideScope videolaryngoscopy compared to direct laryngoscopy. J Emerg Med. 2012 Jun;42(6):629-34.
References
Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. Int J Crit Illn Inj Sci. 2014 Jan;4(1):65-70.
Griscom NT, Wohl ME. Dimensions of the growing trachea related to age and gender. AJR Am J Roentgenol. 1986 Feb;146(2):233-7.
Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010 Oct;113(4):819-24.
Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr. 2004 Mar;144(3):333-7.
Piepho T, Kriege M, Byhahn C, Cavus E, Dörges V, Ilper H, Kehl F, Loop T, Raymondos K, Sujatta S, Timmermann A, Zwißler B, Noppens R. German guidelines for airway management 2023. Anaesthesiologie. 2024 May 16;
Long B, Gottlieb M. Emergency medicine updates: Endotracheal intubation. Am J Emerg Med. 2024 Nov;85:108-116.
Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: dispelling myths and establishing the facts. Emerg Med J. 2005 Jun;22(6):394-6.
Shen CM, Soong WJ, Jeng MJ, Lee YS, Cheng CY, Sun J, Hwang B. Nasopharyngeal tract length measurement in infants. Acta Paediatr Taiwan. 2002 Mar-Apr;43(2):82-5.
Davis DP, Koprowicz KM, Newgard CD, Daya M, Bulger EM, Stiell I, Nichol G, Stephens S, Dreyer J, Minei J, Kerby JD. The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale Scores of 8 or less. Prehosp Emerg Care. 2011 Apr-Jun;15(2):184-92.
Daugherty RJ, Nadkarni V, Brenn BR. Endotracheal tube size estimation for children with pathological short stature. Pediatr Emerg Care. 2006 Nov;22(11):710-7.
Mosier JM, Stolz U, Chiu S, Sakles JC. Difficult airway management in the emergency department: GlideScope videolaryngoscopy compared to direct laryngoscopy. J Emerg Med. 2012 Jun;42(6):629-34.