Evidence-Based Guidelines for Prehospital Airway Management: Methods and Resources Document

Abstract

Introduction

Emergency airway management is a common and critical task EMS clinicians perform in the prehospital setting. A new set of evidence-based guidelines (EBG) was developed to assist in prehospital airway management decision-making. We aim to describe the methods used to develop these EBGs.

Methods

The EBG development process leveraged the four key questions from a prior systematic review conducted by the Agency for Healthcare Research and Quality (AHRQ) to develop 22 different population, intervention, comparison, and outcome (PICO) questions. Evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and tabulated into the summary of findings tables. The technical expert panel then used a rigorous systematic method to generate evidence to decision tables, including leveraging the PanelVoice function of GRADEpro. This process involved a review of the summary of findings tables, asynchronous member judging, and online facilitated panel discussions to generate final consensus-based recommendations.

Results

The panel completed the described work product from September 2022 to April 2023. A total of 17 summary of findings tables and 16 evidence to decision tables were generated through this process. For these recommendations, the overall certainty in evidence was “very low” or “low,” data for decisions on cost-effectiveness and equity were lacking, and feasibility was rated well across all categories. Based on the evidence, 16 “conditional recommendations” were made, with six PICO questions lacking sufficient evidence to generate recommendations.

Conclusion

The EBGs for prehospital airway management were developed by leveraging validated techniques, including the GRADE methodology and a rigorous systematic approach to consensus building to identify treatment recommendations. This process allowed the mitigation of many virtual and electronic communication confounders while managing several PICO questions to be evaluated consistently. Recognizing the increased need for rigorous evidence evaluation and recommendation development, this approach allows for transparency in the development processes and may inform future guideline development.

This article is referred to by:

Prehospital Airway Management – the Continued Search for Evidence

This article is related to:

Evidence-Based Guideline for Prehospital Airway Management

Acknowledgments

This document’s contents are those of the author(s) and do not necessarily represent the U.S. government’s official views or an endorsement. For more information, please visit EMS.gov and HRSA.gov.

Author Contributions

CBG, JRP, and ARP conceived, designed, and collected the data. All authors analyzed the data. CBG, JRP, ESL, and ARP drafted the manuscript. All authors contributed substantially to the interpretation of the data and revision of the manuscript. CBG takes responsibility for the paper as a whole.

Disclosure Statement

Christopher Gage, Jonathan Powell, Nicole Bossom, Remle Crowe, Kyle Guilde, Matthew Yeunge, Davis Maclean, Lorin Browne, Eddy Lang, and Ashish Panchal report no potential conflicts of interest. Jeffrey L. Jarvis and J. Matthew Sholl report receiving honoraria from NASEMSO for their work as co-principal investigators on this project.

Additional information

Funding

The authors thank the National Highway Traffic Safety Administration, its Office of Emergency Medical Services, and the National Association of State EMS Officials for supporting this work.