In Reply: As we indicated in our article, our study did not collect information on the process of advanced airway management, which would require independent observers. This information would have been beneficial to assess the potential mechanisms between airway management and survival outcomes. In contrast, our nationwide study reflects the effectiveness of advanced airway management in the setting of current practice in a developed nation.
We agree with Dr Bernhard and colleagues that advanced airway techniques may be superior to conventional bag-valve-mask ventilation if one accepts the validity and generalizability of the study they cite.1 That study was a manikin study reporting superior success rates with supraglottic airway devices placed by medical students and was not a real-world assessment of airway management in the prehospital setting.
The sensitivity analysis illustrates how powerful a single confounder would have to be to fully account for the disadvantage of advanced airway management over bag-valve-mask ventilation in patients with out-of-hospital cardiac arrests that was detected in the adjusted analysis.
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