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Comment & Response
January 1/8, 2019

Laryngeal Tube Insertion vs Endotracheal Intubation for Out-of-Hospital Cardiac Arrest

Author Affiliations
  • 1Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
  • 2Department of Anesthesiology and Perioperative Medicine, M. D. Anderson Cancer Center, Houston, Texas
JAMA. 2019;321(1):105. doi:10.1001/jama.2018.18107

To the Editor Dr Wang and colleagues1 found that a strategy of initial laryngeal tube (LT) insertion vs endotracheal intubation (ETI) in patients with out-of-hospital cardiac arrest (OHCA) was associated with greater survival. We have some concerns regarding the results and the applicability of the conclusions.

First, the training level and experience of the paramedics participating in the trial were not categorized. Endotracheal intubation is technically more demanding and requires more experience compared with LT insertion. On occasion, LT ventilation is inadequate, which can be difficult to assess even by experienced anesthesiologists and especially in arrested patients. There was a significantly lower initial ETI success rate in this trial (51.6% with ETI vs 90.3% with LT), which may be caused by different criteria in judging airway failure, less advanced equipment used, or less experienced paramedic participants.