Background Over 80% of the 30,000 out-of-hospital cardiac arrest (OHCA) patients treated in the UK each year receive advanced airway management (tracheal tube or supraglottic airway). Recent data from large randomised control trials have highlighted uncertainty regarding the clinical benefits of tracheal intubation and may have driven changes in ambulance service policy. We conducted a survey study to investigate the current UK ambulance service policy on the use of tracheal intubation during adult cardiac arrest.

Methods We surveyed all UK ambulance services using an online survey platform to determine which staff groups are permitted to perform tracheal intubation and associated information linked to advanced airway management in adult cardiac arrest. A single representative of each ambulance service was requested to respond to the survey. The University of Warwick Biomedical & Scientific Research Ethics Committee provided ethical approval for the study.

Results We received survey responses from all 14 UK NHS ambulance services (response rate 100%).

Five ambulance services (35.71%) do not permit non-specialist paramedics to perform tracheal intubation at adult out-of-hospital cardiac arrest. Of these services, the first service to withdraw tracheal intubation did so in 2010, whilst the remaining four did so from 2019 onwards. One further ambulance service stated they are currently in the process of withdrawing tracheal intubation.

Of the five services that have withdrawn tracheal intubation, cited reasons for the policy change were challenges in providing ongoing training (n=5, 100%), results of clinical trials (n=4, 80%), clinical incidents of tracheal tube misplacement (n=4, 80%), and low tracheal intubation success rate (n=3, 60%).

All 14 ambulance services (100%) reported that waveform capnography was available to ambulance crews.

Conclusion This study identified UK ambulance service policy variations concerning non-specialist paramedic use of tracheal intubation in adult cardiac arrest. The clinical impact of this variation requires further research.