Airway Management Strategies during Out-of-Hospital Cardiac Arrest in a South African Private Emergency Medical Service: A Retrospective Review

Abstract Background Out-of-Hospital Cardiac Arrest (OHCA) remains a major cause of mortality globally, with survival dependent on early, high-quality resuscitation. While airway management is a critical component of care, no single strategy has demonstrated clear superiority in improving outcomes. In South Africa, limited data exist describing real-world airway practices in the prehospital setting. This study aimed to describe airway management practices used during OHCA by a private emergency medical service (EMS) in South Africa (SA). Methods A retrospective descriptive review was conducted using electronic patient report forms from a national private EMS between January 2022 and June 2025. Cases involving OHCA with at least one documented airway intervention were included. Airway strategies were categorised as basic airway manoeuvres, supraglottic airway (SGA) devices, and endotracheal intubation (ETI). Data was analysed using descriptive statistics, with frequencies and percentages reported for categorical variables and means for continuous variables. Results A total of 991 OHCA cases met the inclusion criteria. Supraglottic airway devices were the most frequently used intervention (44%), followed by endotracheal intubation (26%), and basic airway manoeuvres (22%). All ETI procedures were performed by Emergency Care Practitioners (ECPs), while SGAs were used exclusively by Paramedics (ANTs), demonstrating adherence to the scope of practice. Basic airway manoeuvres were performed across multiple prehospital provider levels. The mean dispatch-to-scene response times ranged between 12 and 14 minutes across all airway categories. Conclusion Airway management practices within this private South African EMS align with global trends, with a preference for simpler, faster, and less-interruptive airway techniques during OHCA. The findings highlight the importance of context-specific, competence-driven airway selection and provide valuable insight into prehospital resuscitation practices in a resource-limited setting. Further research incorporating patient outcomes is recommended to better understand the clinical impact of these strategies.