Illustration of supraglottic airway device replacing endotracheal tube.

Endotracheal Intubation: Is It Time to Rethink the Gold Standard?

Samir D’Costa in Health & Wellness August 2025 • 4 min read.

"Emerging research questions the long-held belief that endotracheal intubation is always the best approach to airway management. Discover why supraglottic devices are gaining traction and what this means for patient care."

Endotracheal intubation has long been considered the gold standard for advanced airway management, particularly in emergency situations and for patients requiring ventilation. The procedure involves inserting a tube into the trachea to ensure a secure and patent airway, allowing for controlled ventilation and protection against aspiration.

However, recent research is prompting a re-evaluation of this long-held belief. Studies are increasingly highlighting the potential benefits of supraglottic airway devices (SGAs) as effective alternatives, especially in certain scenarios. These devices, which are easier and faster to insert than endotracheal tubes, are challenging the conventional wisdom surrounding airway management.

This article explores the evolving landscape of airway management, examining the evidence that supports the use of supraglottic devices and questioning whether endotracheal intubation should remain the default choice. We'll delve into the factors driving this shift, the implications for patient care, and what this means for medical professionals involved in airway management.

The Rise of Supraglottic Airway Devices: Challenging the Status Quo

Illustration of supraglottic airway device replacing endotracheal tube.

Supraglottic airway devices (SGAs) represent a diverse group of tools designed to establish an airway without requiring direct visualization of the vocal cords. Unlike endotracheal intubation, SGAs are typically inserted blindly, making them faster and easier to use, especially in emergency situations where time is of the essence.

Several factors contribute to the growing interest in SGAs:

Ease of Use: SGAs require less training and expertise compared to endotracheal intubation, making them accessible to a wider range of healthcare providers.
Speed of Insertion: SGAs can be inserted more quickly than endotracheal tubes, which is crucial in critical situations where every second counts.
Reduced Complications: Studies suggest that SGAs may be associated with fewer complications, such as esophageal intubation and airway trauma, compared to endotracheal intubation.
Comparable Outcomes: Research indicates that SGAs can provide comparable ventilation and oxygenation to endotracheal intubation in many clinical scenarios.

While SGAs offer several advantages, it's important to acknowledge their limitations. SGAs may not provide as secure an airway as endotracheal intubation, and they may not be suitable for patients at high risk of aspiration or those requiring prolonged ventilation.

Redefining the Approach to Airway Management

The evidence suggests that SGAs are a valuable alternative to endotracheal intubation in many clinical scenarios. While endotracheal intubation remains an important skill for healthcare providers, it may no longer be appropriate to consider it the default choice for all patients requiring airway management.

The decision of whether to use an SGA or endotracheal intubation should be based on a careful assessment of the patient's condition, the available resources, and the expertise of the healthcare provider. Factors to consider include the patient's risk of aspiration, the need for prolonged ventilation, and the presence of any anatomical abnormalities that may make endotracheal intubation difficult.

Ultimately, the goal of airway management is to provide the best possible care for the patient. By embracing new evidence and adapting our practices, we can ensure that patients receive the most appropriate and effective airway management strategies.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.ajem.2018.10.026, Alternate LINK

Title: The End Of The Era Of Endotracheal Intubation As The Golden Standard Of Airway Management

Subject: Emergency Medicine

Journal: The American Journal of Emergency Medicine

Publisher: Elsevier BV

Authors: Michael Czekajlo, Elzbieta Makomaska-Szaroszyk, Michal Paprocki, Kurt Ruetzler, Jacek Smereka

Published: 2019-06-01

Everything You Need To Know

What is endotracheal intubation and why has it been considered so important?

Endotracheal intubation has long been considered the gold standard for advanced airway management. It is a procedure where a tube is inserted into the trachea to secure the airway and allow for controlled ventilation and prevent aspiration. The significance lies in its established use in emergency situations and for patients requiring ventilation. However, current research suggests that the long held belief should be re-evaluated because alternatives like supraglottic devices are emerging.

What are Supraglottic airway devices (SGAs), and what is their significance?

Supraglottic airway devices (SGAs) are tools designed to establish an airway without directly visualizing the vocal cords. They are typically inserted blindly. Unlike endotracheal intubation, SGAs are often faster and easier to use, particularly in emergencies. The implication is a shift away from always using endotracheal intubation, potentially leading to quicker airway management in critical situations.

What factors are contributing to the increasing use of Supraglottic airway devices (SGAs)?

Several factors drive the growing interest in Supraglottic airway devices (SGAs). These include their ease of use, requiring less training than Endotracheal intubation, which makes them accessible to more healthcare providers. The speed of insertion is faster than Endotracheal tubes. They are associated with fewer complications, such as airway trauma, and provide comparable ventilation and oxygenation in many scenarios. These factors are prompting a shift in how healthcare professionals approach airway management.

What is the significance of endotracheal intubation in advanced airway management?

Endotracheal intubation is the traditional, and often still considered, the gold standard for advanced airway management. This involves inserting a tube into the trachea to secure the airway, enabling controlled ventilation and preventing aspiration. The article suggests that Endotracheal intubation may not be the default choice for every patient, it's a crucial skill for healthcare providers, especially in emergency situations. The implication is a potential change in practice, with consideration given to the benefits of alternatives like supraglottic devices.

What are the limitations of Supraglottic airway devices (SGAs), and how does this impact airway management?

While Supraglottic airway devices (SGAs) offer several advantages, they also have limitations. Unlike Endotracheal intubation, SGAs may not provide as secure an airway and may not be suitable for patients at high risk of aspiration or those needing prolonged ventilation. Endotracheal intubation is a proven method. Healthcare providers must assess each patient's condition to determine the best approach to airway management, which may involve a combination of techniques and devices.