Endotracheal tube versus I-gel airway in cardiac arrest in rural and urban settings

Background: Out-of-hospital cardiac arrest affects 400 000 people annually in the United States, with a 10–11% survival rate after treatment by emergency medical services (EMS). Airway management is crucial, with endotracheal intubation (ETI) and supraglottic airway (SGA) devices as primary methods. Objective: This study compares the effectiveness and preferences for ETI versus the I-gel SGA in out-of-hospital cardiac arrest cases among rural and urban EMS providers. Methods: A cross-sectional study of six EMS agencies involved surveying 175 practitioners (79 rural, 96 urban) on demographics, certification levels, experience, preferences and challenges with ETI and I-gel use. Results: Urban staff preferred I-gel while rural respondents preferred ETI. Influencing factors included the long distances that rural providers often travel, which made them favour ETI, while urban providers cited adherence to established guidelines as a key reason for preferring the I-gel SGA. Conclusion: There are distinct preferences and challenges in airway management in urban and rural settings. Tailored training and protocols could improve out-of-hospital cardiac arrest outcomes.