According to a study published in JAMA, initial laryngeal tube (LT) insertion was associated with improved 72-hour survival for out-of-hospital cardiac arrest compared to endotracheal tube intubation (ETI).

ETI has become the standard of care, the authors write, despite “significant rates of unrecognized tube misplacement or dislodgement, need for multiple ETI attempts, and ETI insertion failure.” Researchers conducted a multicenter cluster-crossover randomized trial to compare the effectiveness of initial LT and initial ETI strategies on outcomes in adult OHCA, which affects over 350,000 US adults each year.

The trial included adults with non-traumatic OHCA treated by participating EMS agencies and requiring anticipated ventilatory support or advanced airway management. “EMS personnel followed local protocols for confirmation of airway placement and management of OHCA, including field termination of resuscitation efforts,” they reported.

Results found that the primary outcome, 72-hour survival, was 18.3% in the LT group vs 15.4% in the ETI group. Other results included:

  • Elapsed time from first EMS arrival to airway start was shorter for LT than ETI (median, 9.8 vs 12.5 minutes).
  • Initial LT and ETI success rates (excluding BVM) were 90.3% and 51.6%.
  • Overall LT and ETI airway success rates (initial?+?rescue airway attempts) were 94.2% and 91.5%, respectively.


“In this trial of 3004 adults with OHCA, a strategy of initial LT was associated with modest but significantly greater 72-hour survival than a strategy of initial ETI. There were also statistically significant associations with survival to hospital discharge and favorable neurological status at hospital discharge that favored the LT group,” the researchers concluded.