Effect of Out-of-Hospital Pediatric Endotracheal Intubation on Survival and Neurological Outcome: A Controlled Clinical Trial

Article Abstract:

It may not be necessary for paramedics to intubate children while transporting them to a hospital. Endotracheal intubation (ETI) involves putting a rigid tube down a patient's throat and airway so he or she can breathe. Researchers analyzed the outcome of 820 children transported by ambulance who needed respiratory support. Half received only bag ventilation through a mask and the other half received bag ventilation followed by ETI. Outcomes and survival rates were similar in both groups.

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Out-of-Hospital Intubation of Children

Article Abstract:

It may be premature for paramedics to stop intubating children during ambulance transport. Endotracheal intubation (ETI) involves inserting a rigid tube into the throat and the airway to support breathing. A study found that ETI provided no additional benefit over bag ventilation through a face mask. However, the paramedics were trained on mannequins and had little chance to practice intubation on live patients. It is not clear if they checked the tube regularly to make sure it was in the airway and not the esophagus. Many children in both groups did not receive adequate ventilation.

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A statewide early defibrillation initiative including laypersons and outcome reporting

Article Abstract:

Defibrillation involves using an electric countershock to restore the normal rhythm of an abnormally beating heart or one that has stopped beating. Victims of a heart attack occurring outside the hospital environment have a much greater chance for survival if early and proper defibrillation can be performed. Emergency medical service (EMS) systems that include personnel and equipment needed to perform defibrillation have been implemented in most areas. The continued use of such systems depends on demonstration of their effectiveness in saving victims of heart attacks. A system developed in California for early defibrillation and its effectiveness in saving patients were evaluated. California requires all basic emergency medical technicians (EMTs) to complete training in early defibrillation. Until 1987, when the law was changed, EMTs were not allowed to perform this procedure. Now, over 300,000 persons are eligible to perform it under appropriate circumstances, and the procedure can only be performed only on unconscious, pulseless patients. Outcomes of early defibrillation must be reported to the state. This includes reports on all persons receiving it, regardless of the reason. During the first 46 months of the program, early defibrillation was performed on 1,487 patients, of whom 191 (13 percent) survived long enough to be discharged from the hospital. Following the changes in the laws regarding usage of defibrillation, defibrillators became available for purchase to groups not associated with the EMS system. The Emergency Medical Services Authority helped pass a law requiring laypersons meet certain requirements before they could use such equipment. The program has been a great success so far. A number of people are alive who otherwise would not be so, simply because of this program. Continued efforts will be made to increase the survival rates. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Services, California, Heart attack, Emergency medical technicians, editorial

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