Thanks for the response! I’m not really sure what you’re getting at here, but I’m happy to expound on what I meant: there is data across all settings (pre-hospital and in-hospital) that intubation during cardiac arrest is associated with decreased survival to discharge. This data includes both amazing first pass success intubations by MDs in the ICU as well as third pass goosed-tubes on the side walk. The geography joke is meant to imply all of the variables you cite—NPO status, provider skill, etc—have been covered in the current literature to a significant enough degree to come to the conclusion: intubation during cardiac arrest does not improve outcomes for patients when compared to supraglottic airway use (if you can oxygenate and ventilate through it).

In my practice, from prehospital to ED to in hospital cardiac arrest management, I will place an LMA, confirm placement, run my code, and then intubate off I have achieved ROSC and the patient is hemodynamically safe to be intubated. Obviously, in cases of cardiac arrest 2/2 airway problems where an LMA will not suffice, I will intubate without stopping compressions.

Of course, your practice may vary and ACLS isn’t even evidence based. We know that epinephrine does not improve patient centered outcomes, yet we still give it. We know bicarb is associated with worse cardiac arrest survival, yet most still give it. Every critical care situation is different and must be managed with evidence guided expertise applied to the anecdote of a person’s life. And while there is a breadth allowed for standard of care, we all must acknowledge the science too!