Background: Airway management methods during out-of-hospital cardiac arrest remain controversial. Objectives: This study aimed to compare the impact of using an endotracheal tube introducer with a Macintosh laryngoscope on the first-pass success rates of final-year medical students on a manikin during continuous chest compressions with a mechanical compression device. Methods: Fifty-two final-year students of the faculty of medicine performed endotracheal intubations on a manikin using the Macintosh laryngoscope with and without the endotracheal tube introducer during chest compressions. First-pass success rates, the times of endotracheal intubations, the second endotracheal intubation attempt success rates, and the difficulty level of each method according to the participants' perceptions were measured. Results: First-pass success rates did not differ using an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope. Second endotracheal intubation attempt success rates also did not differ by endotracheal tube introducer use. The usage of an endotracheal tube introducer required significantly longer endotracheal intubation time than using only a Macintosh laryngoscope. The perception of difficulty was significantly lower with endotracheal tube introducer use. Conclusion: The use of an endotracheal tube introducer as an adjunct to a Macintosh laryngoscope is not associated with higher first-pass success rates during mechanical chest compressions in adult simulations performed by final-year medical students. (C) 2020 Elsevier Inc. (C) 2020 Elsevier Inc. All rights reserved.