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

Area of Science:

• Emergency Medicine
• Prehospital Care
• Clinical Guideline Development

Background:

• Emergency airway management is a critical prehospital procedure for EMS clinicians.
• Existing decision-making processes require updated, evidence-based guidance.
• The development of new evidence-based guidelines (EBGs) is essential for improving prehospital airway management.

Purpose of the Study:

• To describe the methods used in developing new evidence-based guidelines (EBGs) for prehospital emergency airway management.
• To outline the systematic approach for creating recommendations based on current evidence.
• To detail the process of translating evidence into actionable clinical guidance for EMS providers.

Main Methods:

• Utilized four key questions from a prior systematic review to formulate 22 population, intervention, comparison, and outcome (PICO) questions.
• Employed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework to evaluate evidence and generate summary of findings tables.
• Conducted a rigorous systematic method involving technical expert panels, asynchronous judging, and online discussions to create evidence-to-decision tables and final consensus-based recommendations.

Main Results:

• Generated 17 summary of findings tables and 16 evidence-to-decision tables between September 2022 and April 2023.
• Overall certainty in evidence was rated as "very low" or "low" for most recommendations.
• Issued 16 "conditional recommendations," with six PICO questions lacking sufficient evidence for guideline development. Feasibility was rated well, but data on cost-effectiveness and equity were limited.

Conclusions:

• The developed EBGs for prehospital airway management utilized validated techniques like GRADE methodology and systematic consensus building.
• The process ensured transparency and mitigated communication confounders, allowing for consistent evaluation of PICO questions.
• This rigorous approach to evidence evaluation and recommendation development can inform future guideline creation in emergency medicine.