ADVANCED AIRWAY MANAGEMENT AMONG PRIMARY CARE HEALTH

BACKGROUND Out-of-hospital cardiopulmonary arrest (CPA) is one of the leading medical emergencies worldwide, with an incidence in Europe of approximately 55 cases per 100,000 inhabitants and an overall survival rate at hospital discharge of close to 8%. In Spain, the estimated incidence is around 25 cases per 100,000 inhabitants, with survival rates that remain moderate and are influenced by delays in the initiation of resuscitation and by the quality of initial advanced life support (1,2).

During Advanced Life Support (ALS), rapid and effective airway management is a critical factor in mitigating hypoxic brain injury. Although endotracheal intubation (ETI) has traditionally been considered the gold standard (1, 3), its performance in out-of-hospital settings by non-anesthesiologists or practitioners with limited technical experience is associated with significant rates of failure, repeated attempts, and prolonged interruptions in chest compressions, which severely compromise coronary and cerebral perfusion (4). In this scenario, supraglottic devices (SGDs) have emerged as a priority first-line alternative that is safe and quick to insert, offering high success rates and minimizing pauses in cardiopulmonary resuscitation (CPR) (5, 6) Current recommendations prioritize techniques that ensure effective ventilation while minimizing interruptions in chest compressions (1).

However, evidence indicates that a significant proportion of healthcare professionals have cognitive and competency deficits in the management of acute care (7). This situation is particularly relevant in primary care, where acute events are infrequent and opportunities for practical training are limited, which accelerates the phenomenon of skill decay (8).

Assessing baseline knowledge is a fundamental step in identifying actual training needs and designing tailored educational interventions. However, there is little evidence regarding the cognitive level of primary care professionals with respect to the management of DSG prior to receiving structured training-a key starting point for guiding competency-based programs and ensuring patient safety.

For all these reasons, the primary objective of this study was to assess the baseline level of theoretical knowledge regarding the management of DSG among primary care healthcare professionals (physicians and nurses) in the Castellón Department of Health. The following were set as secondary objectives:

• Describe the sociodemographic, academic, and employment profiles of the staff being evaluated.
• Identify specific conceptual gaps and common errors in ALS procedures related to the use of DSG.
• Analyze the statistical association between sociodemographic and professional variables and the success rate on the knowledge questionnaire.
• Assess professionals' self-perceived competence and compare it with their objective cognitive/theoretical performance.

Inclusion criteria

• Physicians and nurses with active employment contracts in primary care in the evaluated department.
• An employment contract or appointment lasting more than 6 months.
• Voluntary consent to participate

Exclusion criteria

• Doctors and nurses who were on temporary disability leave or leave of absence at the time of the study.
• Questionnaires that were duplicates or had any blank questions.