Teleguidance-Facilitated Airway Management in Prehospital Emergency Medical Services: A High-Fidelity Randomized...

Managing difficult airways in prehospital settings is particularly challenging, especially in rural or resource-limited environments and during patient transport. Inexperienced providers performing endotracheal intubation (ETI) during ambulance transport may have lower success rates, highlighting the potential value of real-time expert support.

This study aimed to evaluate the effectiveness of real-time teleguidance from a remote airway expert in improving ETI success among inexperienced operators using videolaryngoscopy (VL) in a moving ambulance environment.

This randomized controlled study included paramedic students with no prior clinical experience using VL, all of whom received standardized VL training immediately before participation. Participants were randomized to either a standard group (no external support) or a teleguidance group (remote expert assistance via the VL device's teleconsultation feature). All ETIs were performed on a high-fidelity manikin in a moving ambulance. The primary outcome was first-attempt ETI success. Secondary outcomes included intubation duration, number of attempts, successful glottic visualization, self-perceived confidence, and procedural feasibility.

Ninety-eight participants were enrolled. First-attempt ETI success was significantly higher in the teleguidance group compared with the standard group (79% vs. 49%, p = 0.002). Median intubation time was shorter with teleguidance (30 vs. 61 seconds, p = 0.003), and fewer attempts were required (median 2 vs. 3, p = 0.001). No significant differences were observed in glottic visualization, confidence, or feasibility scores.

In a simulated prehospital setting involving a moving ambulance, real-time teleguidance was associated with higher first-pass ETI success and shorter intubation times among inexperienced providers.