Welcome back to February's Papers of the Month.

Across these three papers, a common theme emerges: many of the things we do every day are based on habit, extrapolation, or long-standing belief rather than direct evidence from the patients and settings we work in. These studies don't give us easy answers, but they do ask better questions — and that's exactly what Papers of the Month is about.

We start in the prehospital environment, looking at airway management and the question of where intubation actually happens. The idea that we need perfect conditions and 360-degree access before attempting an airway is deeply ingrained, particularly in prehospital care. But real life is messy. This paper explores whether intubating inside an ambulance is associated with worse outcomes or complications, or whether it might actually be a reasonable — and sometimes advantageous — option when time and context matter.

Next, we move into cardiac arrest and one of the most basic interventions we perform: defibrillation. Specifically, pad position. Anterior–lateral versus anterior–posterior placement is something many of us were taught early on, often without much discussion. This study looks directly at patients with shockable out-of-hospital cardiac arrest and asks whether initial pad position influences return of spontaneous circulation and downstream outcomes. It's a simple intervention, but one that could have important implications for practice.

Finally, we take on one of the most debated topics in emergency and critical care airway management: ketamine versus etomidate for induction. This large, pragmatic randomised trial examines whether sedative choice affects mortality and peri-intubation cardiovascular collapse in critically ill adults. It challenges some widely held assumptions, particularly around haemodynamic stability, and provides some much-needed clarity in an area that has generated more opinion than data for years.

Taken together, these papers remind us that resuscitation is built on dozens of small decisions. February's Papers of the Month isn't about changing practice overnight — it's about thinking more carefully, questioning dogma, and understanding the evidence behind the choices we make every day.

Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon & Rob