There was no difference in first pass success with a non-supine (ramped) vs supine intubating position in this retrospective study, and composite adverse events were more common when ramped. But patients most likely to be ramped were also obese or had predicted difficult airway.
Advanced airway management (AAM) was associated with increased overall survival in out-of-hospital cardiac arrest (OHCA) (though not survival with favorable neurological outcome) in patients with non-shockable initial rhythm. There was no difference in survival with use of AAM in patients with initial shockable rhythm.
There was no difference in an endotracheal tube vs supraglottic airway for patients with out-of-hospital cardiac arrest in the outcomes of return of spontaneous circulation, survival to admission, survival to discharge, or survival with good neurological outcome in studies with low risk of bias in this large metaanalysis.
It is estimated that to place an endotracheal tube (ETT) successfully in 30-60 seconds, using direct laryngoscopy, would take 3-5 years of experience and 137-243 endotracheal intubations (ETI). Increased experience did not reduce the time chest compressions were paused. The key take home is that ETI during CPR is really hard. Be prepared.
For adults with out-of-hospital cardiac arrest, initial laryngeal tube insertion by emergency medical service providers was associated with improved 72-hour survival, return of spontaneous circulation, hospital survival, favorable neurologic outcome, and airway success compared to initial endotracheal tube insertion.