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The value of advanced airway management during out-of-hospital cardiac arrest is controversial. Previous observational trials have suggested harm associated with prehospital endotracheal intubation by paramedics (NEJM JW Emerg Med Dec 2010 and Acad Emerg Med 2010; 17:918; NEJM JW Emerg Med Feb 2011 and Prehosp Emerg Care 2011; 15:44; NEJM JW Emerg Med Jul 2007 and Prehosp Emerg Care 2007; 11:213; NEJM JW Emerg Med Feb 2013 and JAMA 2013; 309:257).
Using a large Japanese registry of patients with out-of-hospital cardiac arrest managed by nonphysicians, these authors tested the association between prehospital advanced airway management (endotracheal intubation or supraglottic airway) and survival at discharge or one month. After 1:1 time-depen…