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AAP Grand Rounds 3:46-47 (2000)
© 2000 American Academy of Pediatrics

EMERGENCY MEDICINE

Out-of-Hospital Endotracheal Intubation May Worsen Outcome

Source: Gausche M, Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurologic outcome. JAMA. 2000;283:783–790.

The first 20% of the full text of this article appears below.

Airway management is the first of the ABC’s of resuscitation. In the prehospital setting, endotracheal intubation (ETI) is becoming a popular adjunct to bag-valve-mask (BVM) ventilation to secure an unstable airway.1 However, ETI, especially for the pediatric patient, takes more time and requires more skill by prehospital personnel. To compare the survival and neurological outcomes of pediatric patients treated with BVM with those of patients treated with BVM followed by ETI, researchers conducted a 34-month controlled, clinical trial in Los Angeles and Orange counties—two large, urban, rapid-transport EMS systems. Unlike ETI in adult patients, ETI in children was not in the scope of practice for paramedics in these counties. Thus, the investigators trained 2584 paramedics in pediatric airway management, including the use of ETI, and received approval from all 115 paramedic receiving facilities in the study . . . [Full Text of this Article]

Jeffrey R. Avner, MD, FAAP
Pediatric Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY