Management of the difficult airway in emergency medicine: A scoping review of risk factors, techniques and care structures

Abstract Background: Difficult airway management is among the most critical tasks in emergency medicine. Anatomical abnormalities, physiological instability, situational constraints, available equipment and organisational structures may all affect airway management. This scoping review aimed to map the evidence, identify major research themes and describe gaps in emergency difficult airway care. Methods: MEDLINE via PubMed, Cochrane CENTRAL and Google Scholar were searched on 29 November 2024, supplemented by reference-list screening. An update on 3 September 2026 covered publications from 30 November 2024 onwards. Eligible reports addressed difficult airway management in real or simulated emergency settings, including adults and children, training, specialist teams, prediction models and resources. Study selection and data charting were performed by one author. Evidence was mapped descriptively across six thematic categories. No meta-analysis or formal critical appraisal was performed. Results: Fifty-two reports published between 2000 and 2026 were included. Risk factors and prediction models accounted for 16 reports, techniques and procedures for 11, teams and structured programmes for 10, simulation and training for seven, and epidemiology and resource availability for four each. Definitions, populations, study designs and outcomes varied substantially. Paediatric populations and resource-related research were relatively underrepresented. The synthesis identified four connected dimensions: patient characteristics and physiology, techniques and procedures, personnel and teams, and organisation and resources. Conclusions: The difficult airway is a multidimensional care problem. The literature supports consideration of risk assessment, appropriate techniques, training, team structures and resources together, but does not establish a universally superior intervention or organisational model. Consistent definitions, comparable patient-centred outcomes and externally validated prediction models are needed.