Cardiac Arrest Study: Supraglottic Airways Outperform Intubation

The optimal advanced airway strategy for out-of-hospital cardiac arrest remains an intensely debated topic among emergency and critical care physicians. While endotracheal intubation has historically served as the gold standard, recent randomized trials and meta-analyses suggest that supraglottic airway devices offer comparable or superior outcomes, including higher first-attempt success rates (up to 90.3% versus 51.6%) and improved 72-hour survival (18.3% versus 15.4%) [1], alongside a significantly higher likelihood of return of spontaneous circulation [2]. Despite these shifting paradigms and a notable surge in supraglottic airway utilization during the COVID-19 pandemic, where device usage increased from 12% to 37% [3], endotracheal intubation continues to be heavily favored by many emergency medical service agencies, accounting for over 71% of prehospital airways in recent international cohorts [4, 5]. However, when an initial airway attempt fails in the chaotic prehospital environment, the optimal sequence for subsequent rescue interventions remains poorly defined. A massive new nationwide analysis now offers fresh insights into how the specific sequence of airway device selection impacts procedural success in the field, providing critical data to help medical directors refine resuscitation protocols.