Advanced airway management practice patterns and short-term survival in Poland’s national physician-staffed helicopter emergency medical service, 2020–2024: a retrospective observational study

Advanced prehospital airway management involves endotracheal intubation or supraglottic airway placement. Evidence on airway management and survival in combined ground EMS–HEMS care remains limited, particularly regarding technique sequence and outcomes across clinical groups. This study evaluated airway management strategies and short-term survival to hospital handover in the Polish HEMS system, focusing on ground EMS–HEMS cooperation and sequential strategies. This retrospective study analysed registry data from 8,980 adults who underwent endotracheal intubation and/or supraglottic airway placement during Polish HEMS missions in 2020–2024. Airway-management strategies were compared across four mutually exclusive clinical groups: cardiac arrest excluding traumatic cardiac arrest (TCA), TCA, trauma excluding TCA, and neither cardiac arrest nor trauma. Short-term outcome was defined as being alive at hospital handover. In patients with cardiac arrest, this required documented return of spontaneous circulation; patients transferred with ongoing cardiopulmonary resuscitation were classified as not being alive at hospital handover. Univariate analyses assessed associations with short-term survival. Cardiac arrest was the most common diagnosis (41.9%), followed by trauma (41.2%). Of the 8,980 patients included in the study, 2,950 (32.9%) were not alive at hospital handover, including patients with ongoing cardiopulmonary resuscitation. Ground EMS was present before HEMS arrival in 87.4% of cases. HEMS-performed ETI was the most common strategy (49.8%), followed by EMS-performed ETI (22.6%) and SGA followed by ETI strategies (19.0%). Sequential SGA-to-ETI did not differ significantly from HEMS-performed ETI in patients with cardiac arrest excluding TCA, whereas some other airway-management strategies were associated with higher unadjusted odds of not being alive at hospital handover in the remaining clinical groups. Ground EMS presence before HEMS arrival was associated with lower unadjusted odds of not being alive at hospital handover. In the Polish HEMS system, endotracheal intubation remains the predominant method of advanced airway management. Use of an SGA as the final airway device was associated with higher unadjusted odds of not being alive at hospital handover than ETI-based strategies. However, these findings should not be interpreted as evidence of device superiority because the analysis was retrospective, unadjusted, and lacked detailed measures of patient severity and treatment indication.