Our cross-sectional study offers important contemporary perspectives of the current patterns of EMS advanced airway management in the US. Using the large ESO dataset, which encompasses EMS events from across the US, we observed marked decreases in ETI attempts with contrasting increases in SGA attempts.

These trends were most prominent in the cardiac arrest and pediatric cohorts.

Our study is one of the few longitudinal descriptions of prehospital advanced airway management practices in the US and adds to evolving knowledge regarding EMS airway practices.

Our observations potentially reflect several influences on current EMS airway management practices.

The role of paramedic ETI in clinical care is the source of intense international debate, with numerous studies highlighting the associated risks, including ET tube misplacement and dislodgment, oxygen desaturation and bradycardia, interference with cardiopulmonary chest compression quality, and iatrogenic hyperventilation.

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