Changes in airway practice after AIRWAYS-2

This month we've got four cracking UK-led studies that really speak to how pre-hospital and emergency medicine continue to evolve, not just in the kit and skills we use, but in how we think about the whole patient journey.

We'll start with a paper fromAnaesthesia with Pallavicini et al., exploring pre-hospital central venous access for patients in haemorrhagic shock. Drawing on London's Air Ambulance experience, it shows that large-bore central catheters can be placed safely and effectively, delivering earlier transfusion and improved survival to ED arrival. It's high-stakes medicine in extreme circumstances, and this study gives some of the best real-world data we've seen on it.

Next up we look at the impact of a paper that's genuinely changed national practice from Aljanoubi et al. in Resuscitation, looking at what happened after the AIRWAYS-2 trial landed. You'll remember AIRWAYS-2 showed no functional benefit of tracheal intubation over supraglottic airways in OHCA, but did it actually shift behaviour? This registry study of over 70,000 patients shows that it did - and dramatically. The rate of pre-hospital intubation has fallen from around 44 percent in 2014 to 14 percent by 2020, with a clear inflection right after the trial's publication. Real-world proof that evidence can truly change practice.

Then, we turn to two linked Delphi consensus studies from Tim Nutbeam and colleagues, published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. The first, optimising the care of the trapped patient, develops expert-endorsed principles for managing physically trapped casualties, marking a real shift from "movement-minimisation" to time-sensitive, patient-centred extrication. The second, prioritising time-critical injuries and interventions, complements that work by defining which injuries and treatments truly can't wait — creating a shared language for multi-agency teams at the roadside. Together, these papers show how thoughtful, collaborative UK research is shaping the next generation of trauma and resuscitation care — evidence, consensus, and practice all pulling in the same direction.

These latter two papers are from the team at IMPACT; The Centre for Post-Collision Research, Innovation & Translation. We've been lucky enough to collaborate with the team and deliver an online Extrication course which is now available! A bit about the course;

Fire and Rescue Service personnel, Police officers, community response scheme members, and clinicians who respond to collisions or who wish to update their awareness of consensus extrication guidance.

To improve awareness and adoption of evidence-based, patient-focused extrication principles among operational responders by providing a concise, accessible, and practical educational resource that bridges consensus guidance and real-world operational practice.Learning outcomes:

• Describe the evidence base underpinning contemporary extrication practice.
• Apply a patient-focused approach to decision-making during extrication.
• Employ endorsed decision support tools, including EXIT decision aids, to case-based scenarios.
• Recognise and challenge outdated or unsafe norms in extrication practice.

To find out more about the course head over to Post-Collision

Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob