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Comment & Response
January 1/8, 2019

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

Author Affiliations
  • 1Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston
  • 2Department of Biostatistics, University of Washington, Seattle
  • 3Department of Emergency Medicine, Oregon Health and Science University, Portland
JAMA. 2019;321(1):105-106. doi:10.1001/jama.2018.18115

In Reply As Dr Huang and colleagues note, there were small differences in patient and response characteristics between the initial LT and initial ETI groups. However, in predefined subgroup analyses, including cardiac rhythm and response times, these variations were not associated with the observed treatment effects (eFigure 5 in Supplement 2).1 Among the 3004 patients, 116 received LT placement by basic life support personnel; most of the remaining airways were managed by advanced life support paramedics (eTable 3 in Supplement 2). We could not further characterize rescuer airway training and experience. While rescuers reported slightly higher rates of inadequate ventilation with LT than ETI (1.8% vs 0.6%), in cardiac arrest, it is difficult to ascertain ventilatory quality with either technique. Huang and colleagues suggest that paramedics may have altered airway management strategies based on physical findings, but in the challenging setting of cardiac arrest, only limited airway assessment is possible.