Again, as expected with cardiac arrest not seen on television, overall outcomes were dismal. Survival in the first 72 hours was 13.1 percent in the ETI cohort and 13.6 percent with SGA, and a good outcome was observed in 6.8 percent and 6.4 percent, respectively. Unlike the epinephrine trial, however, outcomes remained essentially parallel at all time points in the study.

This study featured several interesting quirks. Patients treated by paramedics randomized to the ETI cohort were far less likely to have any advanced airway attempted, with almost 25 percent of those in the ETI cohort simply receiving no airway attempt compared with 14 percent of those in the SGA group. These patients were managed with bag-valve-mask ventilation as indicated, and the overall rate of good outcome in these patients measured approximately 17 percent. Only 2.3 percent of those in whom an ETI was attempted had a good outcome compared with only 3.2 percent of those in whom SGA was attempted.

Caution: Beware imagining a causal relationship between attempting an advanced airway and poorer outcomes. It is far more likely individual patient factors associated with a better prognosis led to the difference in management strategies, but these data cannot definitively answer questions regarding the necessity of an advanced airway.

The PART study, conducted in the United States and enrolling 3,004 patients, was similar, although with minor differences in design. Rather than randomizing at the individual paramedic level, randomization occurred at the EMS agency level and included crossover periods for each. Additionally, the SGA device used was a laryngeal tube, the most commonly used SGA in the United States.

These authors observed outcomes similar to AIRWAYS-2, with a 72-hour survival of 15.4 percent in the ETI cohort compared to 18.3 percent with SGA. Neurological survival also favored SGA, with good outcomes occurring in only 5 percent of those randomized to ETI compared with 7.1 percent for SGA.

This study is also full of quirks relating to the individual agencies and the devices used. A handful of agencies were made up of EMS providers with only basic life support training. Patients randomized to ETI enrolled by these cohorts received noninvasive ventilation while awaiting the arrival of an advanced life support provider. Additionally, the overall rate of initial airway success was only 51.6 percent with ETI compared to 90.3 percent with SGA. Only one attempt was mandated, but any potential delay or interruption of resuscitative efforts may be interpreted to have deleterious effects on outcomes for the ETI cohort.