***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Out-of-hospital rescuers often perform tracheal intubation ( TI ) prior to other cardiopulmonary resuscitation ( CPR ) interventions . TI is a complex and error-prone procedure that may interfere with other key resuscitation tasks . We compared the effects of TI versus esophageal tracheal combitube ( ETC ) insertion on the accomplishment of other interventions during simulated cardiopulmonary resuscitation . METHODS In this prospect i ve trial using a human simulator , two-paramedic teams simulated resuscitation of a ventricular fibrillation cardiopulmonary arrest using st and ard Advanced Cardiac Life Support guidelines .  In each of two trials , teams used either TI or ETC as the primary airway device . Following delivery of three rescue shocks , we measured time intervals to successful airway placement , intravenous ( IV ) line insertion , drug administration , delivery of fourth rescue shock and completion of all four tasks . We also measured the total time without chest compressions . We compared task completion times using non-parametric statistics ( Wilcoxon signed-ranks test ) with a Bonferroni-adjusted p-value of 0.008 . RESULTS Twenty teams each completed two scenarios . Participants required a median of 172.5 s ( IQR : 146.5 - 225.5 ) to accomplish all four tasks . Elapsed time to airway placement was significantly less for ETC than TI ( median difference 26.5 s ( IQR 13 - 44.5 ) , p=0.002 ) . Time without chest compressions was less for ETC than TI ( median difference 8.5 s ( IQR 2.5 - 23.5 ) , p=0.005 ) . There were no differences between ETC and  TI  in times to IV placement ( median difference 23.5 s ( IQR -20 to 61 ) , p=0.11 ) , drug delivery ( 39.5 s ( IQR -18 to 63 ) , p=0.07 ) , delivery of fourth rescue shock ( 39.5 s ( IQR -21.5 to 87.5 ) , p=0.07 ) or completion of all four tasks ( 33 s ( IQR -11 to 74.5 ) , p=0.08 ) . CONCLUSION Compared with TI , ETC reduced time to airway placement and time without chest compressions , but did not affect elapsed times to accomplish other interventions . Additional time differences may be realized if translated to clinical out-of-hospital conditions BACKGROUND Mortality  among patients admitted to hospital after out-of-hospital cardiac arrest ( OHCA ) is high . Based on recent scientific evidence with a main goal of improving survival , we introduced and implemented a st and ardised post resuscitation protocol focusing on vital organ function including therapeutic hypothermia , percutaneous coronary intervention ( PCI ) , control of haemodynamics , blood glucose , ventilation and seizures . METHODS All patients with OHCA of cardiac aetiology admitted to the ICU from September 2003 to May 2005 ( intervention period ) were included in a prospect i ve , observational study and compared to controls from February 1996 to February 1998 . RESULTS In the control period 15/58 ( 26 % ) survived to hospital discharge with a favourable neurological outcome versus 34 of 61 ( 56 % ) in the intervention period ( OR 3.61 , CI 1.66 - 7.84 , p=0.001 ) . All survivors with a favourable neurological outcome in both groups were still alive 1 year after discharge . Two patients from the control period were revascularised with thrombolytics versus 30 ( 49 % ) receiving PCI treatment in the intervention period ( 47 patients ( 77 % ) underwent cardiac angiography ) .  Therapeutic hypothermia  was not used in the control period , but 40 of 52 ( 77 % ) comatose patients received this treatment in the intervention period . CONCLUSIONS Discharge rate from hospital , neurological outcome and 1-year survival improved after st and ardisation of post resuscitation care . Based on a multivariate logistic analysis , hospital treatment in the intervention period was the most important independent predictor of survival Introduction Both supraglottic airway devices ( SGA ) and endotracheal intubation ( ETI ) have been used by emergency life-saving technicians ( ELST ) in Japan to treat out-of-hospital cardiac arrests ( OHCAs ) . Despite traditional emphasis on airway management during cardiac arrest , its impact on survival from OHCA and time dependent effectiveness remains unclear . Methods All adults with witnessed , non-traumatic OHCA , from 1 January 2005 to 31 December 2008 , treated by the emergency medical services ( EMS ) with an advanced airway in Osaka , Japan were studied in a prospect i ve Utstein-style population cohort data base . The primary outcome measure was one-month survival with neurologically favorable outcome . The association between type of advanced airway ( ETI/SGA ) , timing of device placement and neurological outcome was assessed by multiple logistic regression . Results Of 7,517 witnessed non-traumatic OHCAs , 5,377 cases were treated with advanced airways . Of these , 1,679 were ETI while 3,698 were SGA . Favorable neurological outcome was similar between ETI and SGA ( 3.6 % versus 3.6 % , P = 0.95 ) . The time interval from collapse to ETI placement was significantly longer than for SGA ( 17.2 minutes versus 15.8 minutes , P < 0.001 ) . From multivariate analysis , early placement of an advanced airway was significantly associated with better neurological outcome ( Adjusted Odds Ratio ( AOR ) for one minute delay , 0.91 , 95 % confidence interval ( CI ) 0.88 to 0.95 ) . ETI was not a significant predictor ( AOR 0.71 , 95 % CI 0.39 to 1.30 ) but the presence of an ETI certified ELST ( AOR , 1.86 , 95 % CI 1.04 to 3.34 ) was a significant predictor for favorable neurological outcome . Conclusions There was no difference in neurologically favorable outcome from witnessed OHCA for ETI versus SGA . Early airway management with advanced airway regardless of type and rhythm was associated with improved outcomes Importance Bag-mask ventilation ( BMV ) is a less complex technique than endotracheal intubation ( ETI ) for airway management during the advanced cardiac life support phase of cardiopulmonary resuscitation of patients with out-of-hospital cardiorespiratory arrest . It has been reported as superior in terms of survival . Objectives To assess noninferiority of BMV vs ETI for advanced airway management with regard to survival with favorable neurological function at day 28 . Design , Setting s , and Participants Multicenter r and omized clinical trial comparing BMV with ETI in 2043 patients with out-of-hospital cardiorespiratory arrest in France and Belgium . Enrollment occurred from March 9 , 2015 , to January 2 , 2017 , and follow-up ended January 26 , 2017 . Intervention Participants were r and omized to initial airway management with BMV ( n = 1020 ) or ETI ( n = 1023 ) . Main Outcomes and Measures The primary outcome was favorable neurological outcome at 28 days defined as cerebral performance category 1 or 2 . A noninferiority margin of 1 % was chosen . Secondary end points included rate of survival to hospital admission , rate of survival at day 28 , rate of return of spontaneous circulation , and ETI and BMV difficulty or failure . Results Among 2043 patients who were r and omized ( mean age , 64.7 years ; 665 women [ 32 % ] ) , 2040 ( 99.8 % ) completed the trial . In the intention-to-treat population , favorable functional survival at day 28 was 44 of 1018 patients ( 4.3 % ) in the BMV group and 43 of 1022 patients ( 4.2 % ) in the ETI group ( difference , 0.11 % [ 1-sided 97.5 % CI , −1.64 % to infinity ] ; P for noninferiority = .11 ) . Survival to hospital admission ( 294/1018 [ 28.9 % ] in the BMV group vs 333/1022 [ 32.6 % ] in the ETI group ; difference , −3.7 % [ 95 % CI , −7.7 % to 0.3 % ] ) and global survival at day 28 ( 55/1018 [ 5.4 % ] in the BMV group vs 54/1022 [ 5.3 % ] in the ETI group ; difference , 0.1 % [ 95 % CI , −1.8 % to 2.1 % ] ) were not significantly different . Complications included difficult airway management ( 186/1027 [ 18.1 % ] in the BMV group vs 134/996 [ 13.4 % ] in the ETI group ; difference , 4.7 % [ 95 % CI , 1.5 % to 7.9 % ] ; P = .004 ) , failure ( 69/1028 [ 6.7 % ] in the BMV group vs 21/996 [ 2.1 % ] in the ETI group ; difference , 4.6 % [ 95 % CI , 2.8 % to 6.4 % ] ; P < .001 ) , and regurgitation of gastric content ( 156/1027 [ 15.2 % ] in the BMV group vs 75/999 [ 7.5 % ] in the ETI group ; difference , 7.7 % [ 95 % CI , 4.9 % to 10.4 % ] ; P < .001 ) . Conclusions and Relevance Among patients with out-of-hospital cardiorespiratory arrest , the use of BMV compared with ETI failed to demonstrate noninferiority or inferiority for survival with favorable 28-day neurological function , an inconclusive result . A determination of equivalence or superiority between these techniques requires further research . Trial Registration clinical trials.gov Identifier : BACKGROUND Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest . Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time . The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality . METHODS Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospect i ve observational study . The quality of CPR was measured using the  Q-CPR device ( Phillips , UK ) before and after an advanced airway device ( endotracheal tube [ ET ] or laryngeal mask airway [ LMA ] ) was inserted . Patients receiving only bag-mask ventilation were used as the control cohort . The primary outcome was no flow ratio ( NFR ) . Secondary outcomes were chest compression rate , depth , compressions too shallow , compressions with leaning , ventilation rate , inflation time , change in impedance and time required to successfully insert airway device . RESULTS One hundred patients were enrolled in the study ( 2008 - 2011 ) .  Endotracheal tube and LMA placement took similar duration s ( median 15.8 s ( IQR 6.8 - 19.4 ) vs. LMA median 8.0s ( IQR 5.5 - 15.9 ) , p=0.1 ) . The use of an advanced airway was associated with improved no flow ratios ( endotracheal tube placement ( n=50 ) improved NFR from baseline median 0.24 IQR 0.17 - 0.40 ) to 0.15 to ( IQR 0.09 - 0.28 ) , p=0.012 ; LMA ( n=25 ) from median 0.28 ( IQR 0.23 - 0.40 ) to 0.13 ( IQR 0.11- 0.19 ) , p=0.0001 ) . There was no change in NFR in patients managed solely with bag valve mask ( BVM ) ( n=25 ) ( median 0.29 ( IQR 0.18 - 0.59 ) vs. median 0.26 ( IQR 0.12 - 0.37 ) , p=0.888 ) . There was no significant difference in time taken to successfully insert the airway device between the two groups . CONCLUSION The use of an advanced airway ( ETT or LMA ) during in-hospital cardiac arrest was associated with improved no flow ratio . Further studies are required to determine the effect of airway devices on overall patient outcomes IMPORTANCE It is unclear whether advanced airway management such as endotracheal intubation or use of supraglottic airway devices in the prehospital setting improves outcomes following out-of-hospital cardiac arrest ( OHCA ) compared with conventional bag-valve-mask ventilation . OBJECTIVE To test the hypothesis that prehospital advanced airway management is associated with favorable outcome after adult OHCA . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve , nationwide , population -based study ( All-Japan Utstein Registry ) involving  
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Conclusions : The overall heterogeneous benefit in survival with ETT was not replicated in the low risk RCTs , with no significant difference in survival or neurological outcome .
In the presence of automated chest compressions , ETT intubation may result in survival benefits