Is non-supine positioning preferable in patients requiring intubation in the emergency department?
Given the evidence supporting improved first-pass success with non-supine positioning, consider standardizing an inclined approach during anticipated difficult airways in your department. While this is promising, remember these results are based on a limited number of studies and should complement, not replace, established local protocols for airway management.
This systematic review synthesized evidence regarding whether keeping a patient in a non-supine position improves first-pass success rates during emergency department intubation. The authors searched multiple databases, identifying six prospective studies, including two randomized trials, to assess this practice. Overall, the meta-analysis found a consistent positive association between maintaining patient angulation and achieving successful intubation on the first attempt across three of the included studies. These findings suggest that adopting an inclined positioning protocol might be beneficial for ED airway management.