Prehospital and resuscitative airway care: should the gold standard be reassessed?

In the context of prehospital care and resuscitation, tracheal intubation has been regarded as the standard in airway treatment. The evidence for this status is rather weak. It does not take into account the level of training and experience of the personnel attempting intubation, and whether they use neuromuscular blockers. In unskilled hands, attempted tracheal intubation is harmful; unrecognized esophageal intubation is disastrous. When healthcare providers lack adequate skills in tracheal intubation, alternative airway devices, such as the laryngeal mask airway or the Combitube, may be better options than a simple facemask. Healthcare personnel using any of these devices should be adequately trained and maintain frequent practice.