This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (205)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Social Bookmarking   What's this?

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Out-of-Hospital Endotracheal Intubation of Children
Marc Eckstein, Carolyn Nieman, James Merlino, J. D. Polk, Betty Kovach, Charlene Mancuso, William F. Fallon, Jr, Cynthia Cristofani, Jeffrey S. Sagel, Marianne Gausche, and Roger J. Lewis
JAMA. 2000;283(21):2790-2792.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Out-of-Hospital Intubation of Children
Peter Glaeser
JAMA. 2000;283(6):797-798.
EXTRACT | FULL TEXT  

February 9, 2000
JAMA. 2000;283(6):817-818.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence
von Elm et al.
Br J Anaesth 2009;103:371-386.
ABSTRACT | FULL TEXT  

Prehospital Intubations and Mortality: A Level 1 Trauma Center Perspective
Cobas et al.
Anesth. Analg. 2009;109:489-493.
ABSTRACT | FULL TEXT  

Randomized Trial of Endotracheal Tube Versus Laryngeal Mask Airway in Simulated Prehospital Pediatric Arrest
Chen and Hsiao
Pediatrics 2008;122:e294-e297.
ABSTRACT | FULL TEXT  

Essential Features of Designating Out-of-Hospital Cardiac Arrest as a Reportable Event: A Scientific Statement From the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group
Nichol et al.
Circulation 2008;117:2299-2308.
ABSTRACT | FULL TEXT  

Should invasive airway management be done in the field?
Davis
CMAJ 2008;178:1171-1173.
FULL TEXT  

Resuscitation of patients after traumatic brain injury
Hulme
Trauma 2008;10:55-63.
ABSTRACT  

Use of Bedside Ultrasonography for Endotracheal Tube Placement in Pediatric Patients: A Feasibility Study
Galicinao et al.
Pediatrics 2007;120:1297-1303.
ABSTRACT | FULL TEXT  

Interfacility Transport of the Critically Ill Pediatric Patient
Ajizian and Nakagawa
Chest 2007;132:1361-1367.
ABSTRACT | FULL TEXT  

Traumatic brain injury: assessment, resuscitation and early management
Moppett
Br J Anaesth 2007;99:18-31.
ABSTRACT | FULL TEXT  

Field Airway Management Disasters
von Goedecke et al.
Anesth. Analg. 2007;104:481-483.
FULL TEXT  

Bayesian decision-theoretic group sequential clinical trial design based on a quadratic loss function: a frequentist evaluation
Lewis et al.
Clin Trials 2007;4:5-14.
ABSTRACT  

Cuffed endotracheal tube use in paediatric prehospital intubation: challenging the doctrine?
Clements et al.
Emerg. Med. J. 2007;24:57-58.
ABSTRACT | FULL TEXT  

Emergency Medical Services System Changes Reduce Pediatric Epinephrine Dosing Errors in the Prehospital Setting
Kaji et al.
Pediatrics 2006;118:1493-1500.
ABSTRACT | FULL TEXT  

Case records of the Massachusetts General Hospital. Case 16-2006. A 72-year-old woman admitted to the emergency department because of a sudden change in mental status.
Thomas et al.
NEJM 2006;354:2263-2271.
FULL TEXT  

2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Basic Life Support
American Heart Association
Pediatrics 2006;117:e989-e1004.
ABSTRACT | FULL TEXT  

2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Advanced Life Support
American Heart Association
Pediatrics 2006;117:e1005-e1028.
FULL TEXT  

The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support
The International Liaison Committee on Resuscitati
Pediatrics 2006;117:e955-e977.
ABSTRACT | FULL TEXT  

Factors influencing emergency intubation in the pre-hospital setting--a multicentre study in the German Helicopter Emergency Medical Service
Helm et al.
Br J Anaesth 2006;96:67-71.
ABSTRACT | FULL TEXT  

Part 7.1: Adjuncts for Airway Control and Ventilation
Circulation 2005;112:IV-51-IV-57.
FULL TEXT  

Part 10.7: Cardiac Arrest Associated With Trauma
Circulation 2005;112:IV-146-IV-149.
FULL TEXT  

Part 11: Pediatric Basic Life Support
Circulation 2005;112:IV-156-IV-166.
FULL TEXT  

Part 12: Pediatric Advanced Life Support
Circulation 2005;112:IV-167-IV-187.
FULL TEXT  

Pre-hospital trauma care: systems and delivery
Lockey and Deakin
Contin Educ Anaesth Crit Care Pain 2005;5:191-194.
FULL TEXT  

Part 4: Advanced Life Support
Circulation 2005;112:III-25-III-54.
FULL TEXT  

Part 6: Pediatric Basic and Advanced Life Support
Circulation 2005;112:III-73-III-90.
FULL TEXT  

A review of emergency equipment carried and procedures performed by UK front line paramedics on paediatric patients
Roberts et al.
Emerg. Med. J. 2005;22:572-576.
ABSTRACT | FULL TEXT  

Cardiocerebral Resuscitation: The New Cardiopulmonary Resuscitation
Ewy
Circulation 2005;111:2134-2142.
FULL TEXT  

Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics
Deakin et al.
Emerg. Med. J. 2005;22:64-67.
ABSTRACT | FULL TEXT  

Role of Pediatricians in Advocating Life Support Training Courses for Parents and the Public
Pyles et al.
Pediatrics 2004;114:e761-e765.
ABSTRACT | FULL TEXT  

Group Sequential Design for Comparative Diagnostic Accuracy Studies: Implications and Guidelines for Practitioners
Mazumdar
Med Decis Making 2004;24:525-533.
ABSTRACT  

Emergency induction of anaesthesia in the prehospital setting: a review of the anaesthetic induction agents
Easby and Dodds
Trauma 2004;6:217-224.
ABSTRACT  

The LMA ProSeal TM May Not Be the Best Option for Difficult to Intubate/Ventilate Patients * Response
Dunn et al.
Anesth. Analg. 2004;99:310-311.
FULL TEXT  

A Prospective, Population-Based Study of the Epidemiology and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest
Young et al.
Pediatrics 2004;114:157-164.
ABSTRACT | FULL TEXT  

Paediatric prehospital trauma
Jewkes
Trauma 2004;6:121-133.
ABSTRACT  

Prehospital Care of the Multiply Injured Patient: The Challenge of Figuring Out What Works
Lewis
JAMA 2004;291:1382-1384.
FULL TEXT  

Measuring the Quality of Children's Health Care: A Prerequisite to Action
Dougherty and Simpson
Pediatrics 2004;113:185-198.
ABSTRACT | FULL TEXT  

Prevention of injuries to children and adolescents
Rivara
Inj. Prev. 2002;8:iv5-8.
ABSTRACT | FULL TEXT  

Randomised trials in surgery: problems and possible solutions
McCulloch et al.
BMJ 2002;324:1448-1451.
FULL TEXT  

Transtracheal Oxygenation : An Alternative to Endotracheal Intubation During Cardiac Arrest
Ayoub et al.
Chest 2001;120:1663-1670.
ABSTRACT | FULL TEXT  

Effects of 2 Patterns of Prehospital Care on the Outcome of Patients With Severe Head Injury
Di Bartolomeo et al.
Arch Surg 2001;136:1293-1300.
ABSTRACT | FULL TEXT  

Cardiopulmonary Resuscitation Performed by Bystanders Does Not Increase Adverse Effects as Assessed by Chest Radiography
Oschatz et al.
Anesth. Analg. 2001;93:128-133.
ABSTRACT | FULL TEXT  

Guidelines for Preparedness of Emergency Departments That Care for Children: A Call to Action
Gausche-Hill and Wiebe
Pediatrics 2001;107:773-774.
FULL TEXT  

Current topic: Prehospital emergency care for children
Jewkes
Arch. Dis. Child. 2001;84:103-105.
FULL TEXT  

Out-of-Hospital Endotracheal Intubation of Children
Eckstein et al.
JAMA 2000;283:2790-2792.
FULL TEXT  

Out-of-Hospital Pediatric Endotracheal Intubation Not Superior to BVM Ventilation
JWatch Emergency Med. 2000;2000:1-1.
FULL TEXT  

Out-of-Hospital Intubation of Children
Glaeser
JAMA 2000;283:797-798.
FULL TEXT