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Positioning during endotracheal intubation (ETI) is critical to ensure its success. We aimed to determine if the ramping position improved laryngeal exposure and first attempt success at intubation when compared to the sniffing position. PubMed, EMBASE, and Cochrane CENTRAL databases were searched systematically from inception until January2020. Our primary outcomes included laryngeal exposure as measured by Cormack-Lehane Grade1or2 (CLG 1/2), CLG3or4 (CLG 3/4), and first attempt success at intubation. Secondary outcomes were intubation