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So should you be intubating your patient in cardiac arrest? There’s evidence that during the initial resuscitation, there may be a better choice.

Most guidelines say that the decision to place an endotracheal tube early during a cardiac arrest is a judgment call based on the situation and the level of experience of available providers. Some clinical situations may require early endotracheal tube placement.

Before you do however, consider the evidence and advantages of a supraglottic airway device (SAD) in cardiac arrest. It’s faster and easier to place, less likely to interrupt chest compressions, and has a higher insertion success rate (even for less experienced providers).

So before you intubate a cardiac arrest patient, size up the situation, evaluate your resources, and ask yourself if an endotracheal tube is the right first choice in airway management.

Patients in refractory or prolonged cardiac arrest (15-30 min) may benefit from intubation, particularly if the patient is an ECMO candidate at a facility that can perform it. Recent ECMO studies suggest intubated patients have less asphyxia physiology, increased candidacy rate for ECPR, and increased neurologically favorable survival to discharge with ETI compared to SGA.