Noha Salaheldeen Taha Mahde, Ibrahim Abdelhafiz Ibrahim Ahmed, Amgad Elhadi Mousa Mohamed, Khawla Abdalrouf Mohammad Khair Suliman, Arwa Eltayeb Ahmed Ibrahim, Mahdi Hamdan Salih Elnemair, Dina Abdelnaser Ahmed Hussein, Mohamed Yasin Humaida Ibrahim, Momen Babiker Eltayab Eltayar, Husameldin Ali Babiker, Aya Ismail Ahmed Mohammedzain, Weam Mohamed Elhadi Bashir Eltayeb, Randa Azhari Badawi Abdelmagid, Aya Abdelfattah Kaml Hassan, Khalid Monawar, Mohammedomer Eltayeb, Malaz Elkhalifa, Mustafa Mohamed, Marwa Yousif Suliman Mohamed, Tala Siefuddin Awadelkarim Mohamed, Omar Abdelmajeed Maryoud Elbashir, Abdalmahmoud Asadig Kanan Ahmed, Samar Ahmed Abdelaziz Ibrahim
Background Effective airway management is a critical component of cardiopulmonary resuscitation (CPR) and emergency care. Deficiencies in healthcare professionals' knowledge of and adherence to evidence-based airway management principles may compromise the quality of resuscitation and patient outcomes. This study aimed to evaluate the effectiveness of a multifaceted quality improvement intervention in improving healthcare professionals' knowledge of and adherence to Advanced Cardiovascular Life Support (ACLS) airway management principles through a closed-loop clinical audit. Methods A prospective closed-loop clinical audit was conducted at Almanagil Teaching Hospital, Sudan. The first audit cycle was performed over two weeks (1 March-14 March 2026) and included 50 healthcare professionals comprising house officers, medical officers, and registrars. Baseline knowledge of airway management was assessed using a structured questionnaire based on the 2025 American Heart Association (AHA) ACLS guidelines. Following the initial assessment, a one-month quality improvement program incorporating structured educational sessions, practical demonstrations, educational materials, visual reminders, and regular feedback was implemented. A second audit cycle involving 50 participants was conducted over two months (15 April-14 June 2026) using the same methodology. Compliance rates between audit cycles were compared using the chi-square test, with statistical significance defined as p<0.05. Results Marked improvements were observed across most assessed airway management domains following implementation of the quality improvement intervention. Significant improvements were demonstrated in minimizing interruptions in chest compressions during intubation (66.0% vs. 96.0%, p 0.001), use of waveform capnography for airway confirmation (66.0% vs. 98.0%, p<0.001), knowledge of the maximum recommended interruption time during CPR (46.0% vs. 98.0%, p<0.001), continuous chest compressions following advanced airway placement (8.0% vs. 68.0%, p<0.001), knowledge of airway adjuncts (42.0% vs. 82.0%, p<0.001), understanding of the significance of end-tidal carbon dioxide (ETCO₂) during CPR (48.0% vs. 88.0%, p<0.001), and leadership during resuscitation (78.0% vs. 98.0%, p=0.002). Although improvements were also observed in bag-valve-mask ventilation, recognition of poor airway management practices, and knowledge of hyperventilation, these changes did not reach statistical significance. Conclusions A structured, multifaceted educational intervention implemented through a closed-loop clinical audit was associated with significant improvements in healthcare professionals' knowledge of and adherence to evidence-based airway management principles. Regular clinical audit, targeted education, practical reinforcement, and continuous feedback represent feasible and effective quality improvement strategies for strengthening airway management practices, particularly in resource-limited healthcare settings. Continued re-audit and competency-based training are recommended to sustain these improvements and promote safer emergency care.