Most arrest patients that arrive in our hospital are intubated pre-hospital by paramedics. The benefits/harm of prehospital intubation can certainly be debated, but that's for another time. The few that aren't intubated were either difficult or had too many other complicating issues and so present with some type of supraglottic device or just a BVM. My approach (as I'm typically the only physician in the room) is to run the code until there's ROSC and at that point establish a definitive airway - if there's no ROSC then I don't feel the need to establish an airway just to pronounce a patient. I was surprised to hear that many residents are taught the need to do so, leading to prolonged pauses in compressions (this is bound to happen even with the best of intentions). It reminded me of my own time in residency and thinking back on it there was always a sense that an airway needed to be established, and there was almost always a pause in compressions to do so. I fail to see the need to establish a definitive airway when a patient's easy to bag and compression effectiveness can be maximized. Others thoughts?