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To the Editor: Dr Gausche and colleagues¹ found that out-of-hospital pediatric intubation by paramedics did not improve survival or neurological outcome. However, the 6 hours of classroom training may have been inadequate for paramedics to learn to perform endotracheal intubation (ETI) on critically ill children in the out-of-hospital setting.

The 83% rate of adequate chest rise in patients who received bag-valve-mask ventilation (BVM) or ETI suggests inadequate technique. Even more troubling was the fact that paramedics used end-tidal carbon dioxide detectors in only 3 of 4 patients they intubated. Even fewer patients had continuous monitoring during transport when tubes are most likely to become dislodged. We should demand a 100% usage rate of end-tidal carbon dioxide detectors in the out-of-hospital setting as we do in the hospital.²

Should we abandon the practice of prehospital pediatric ETI or reevaluate the level of paramedic training and supervision? An earlier study by Gausche . . . [Full Text of this Article]

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RELATED ARTICLE

Effect of Out-of-Hospital Pediatric Endotracheal Intubation on Survival and Neurological Outcome: A Controlled Clinical Trial
Marianne Gausche, Roger J. Lewis, Samuel J. Stratton, Bruce E. Haynes, Carol S. Gunter, Suzanne M. Goodrich, Pamela D. Poore, Maureen D. McCollough, Deborah P. Henderson, Franklin D. Pratt, and James S. Seidel
JAMA. 2000;283(6):783-790.
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