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A Controlled Clinical Trial

Marianne Gausche, MD; Roger J. Lewis, MD, PhD; Samuel J. Stratton, MD, MPH; Bruce E. Haynes, MD; Carol S. Gunter, BSN, MPA; Suzanne M. Goodrich, RN, MSN; Pamela D. Poore, RN; Maureen D. McCollough, MD, MPH; Deborah P. Henderson, PhD, RN; Franklin D. Pratt, MD; James S. Seidel, MD, PhD

JAMA. 2000;283:783-790.

Context  Endotracheal intubation (ETI) is widely used for airway management of children in the out-of-hospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome.

Objective  To compare the survival and neurological outcomes of pediatric patients treated with bag-valve-mask ventilation (BVM) with those of patients treated with BVM followed by ETI.

Design  Controlled clinical trial, in which patients were assigned to interventions by calendar day from March 15, 1994, through January 1, 1997.

Setting  Two large, urban, rapid-transport emergency medical services (EMS) systems.

Participants  A total of 830 consecutive patients aged 12 years or younger or estimated to weigh less than 40 kg who required airway management; 820 were available for follow-up.

Interventions  Patients were assigned to receive either BVM (odd days; n = 410) or BVM followed by ETI (even days; n = 420).

Main Outcome Measures  Survival to hospital discharge and neurological status at discharge from an acute care hospital compared by treatment group.

Results  There was no significant difference in survival between the BVM group (123/404 [30%]) and the ETI group (110/416 [26%]) (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.61-1.11) or in the rate of achieving a good neurological outcome (BVM, 92/404 [23%] vs ETI, 85/416 [20%]) (OR, 0.87; 95% CI, 0.62-1.22).

Conclusion  These results indicate that the addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system.

Author Affiliations: Department of Emergency Medicine (Drs Gausche, Lewis, Stratton, McCollough, Pratt, and Seidel), Department of Pediatrics (Dr Seidel), Harbor-UCLA Medical Center, and Harbor-UCLA Research and Education Institute (Drs Gausche, Lewis, Stratton, McCollough, Henderson, and Seidel and Mss Goodrich and Poore), Torrance; Department of Medicine (Drs Gausche, Lewis, Stratton, McCollough, and Seidel) and Department of Pediatrics (Dr Seidel), UCLA School of Medicine, Division of Learning and Instruction, USC School of Education (Dr Henderson), and Los Angeles County Fire Department (Dr Pratt), Los Angeles; Los Angeles County Emergency Medical Services Agency, Torrance (Dr Stratton and Ms Gunter); and Orange County Emergency Medical Services Agency, Santa Ana (Dr Haynes), Calif.

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