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Airway Pragmatism in Out-of-Hospital Cardiac Arrest — Endotracheal Intubation VS. Supraglottics: Which is best?

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac ArrestHenry E. Wang, MD, MS; Robert H. Schmicker, MS; Mohamud R. Daya, MD, MS; Shannon W. Stephens, EMT-P; Ahamed H. Idris, MD; Jestin N. Carlson, MD, MS; M. Riccardo Colella, DO, MPH; Heather Herren, MPH, RN; Matthew Hansen, MD, MCR; Neal J. Richmond, MD; Juan Carlos J. Puyana, BA; Tom P. Aufderheide, MD, MS; Randal E. Gray, MEd, NREMT-P; Pamela C. Gray, NREMT-P; Mike Verkest, AAS, EMT-P; Pamela C. Owens; Ashley M. Brienza, BS; Kenneth J. Sternig, MS-EHS, BSN, NRP; Susanne J. May, PhD; George R. Sopko, MD, MPH; Myron L. Weisfeldt, MD; Graham Nichol, MD, MPH

Endotracheal intubation (ETI) is commonly performed on patients with cardiac arrest in countries with advanced emergency medical services (EMS) systems. However, in recent years, ETI has played a controversial role in EMS care. Numerous studies have highlighted the challenges of paramedic ETI, causing many EMS agencies to use an alternative method, such as supraglottic airway (SGA), as the primary method of ventilation during Out-of-Hospital Cardiac Arrest (OHCA) resuscitation. Despite the challenges of ETI, multiple observational studies have reported better outcomes associated with ETI compared with SGAs.

The authors of this study compared the effectiveness of an initial airway management strategy using laryngeal tube (LT) insertion to ETI in adults with OHCA. They conducted a multicenter cluster-crossover randomized trail including 27 EMS agencies associated with US sites of the Resuscitation Outcomes Consortium. The trial included adults with non-traumatic OHCA treated by the participating EMS agencies and requiring anticipated ventilatory support or advanced airway management. The EMS agencies were randomized to either of two initial advanced airway management strategies: initial LT insertion or initial orotracheal ETI.
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