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Research Shows Simple Resuscitation Method as Best for Children in Out-of-Hospital Emergency Settings

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Press Release Date: February 8, 2000

Researchers urged paramedics to stop using intubation to resuscitate children after finding that a simple artificial respiration method saves the lives of children who have stopped breathing as well as the more risky intubation procedure. The 3-year study of 830 patients, funded by the Health Resources and Services Administration's Maternal and Child Health Bureau, in collaboration with the Agency for Healthcare Research and Quality, is published in the February 9 issue of the Journal of the American Medical Association.

HRSA Administrator Claude Earl Fox, M.D., M.P.H., said, "Intubation has been an accepted procedure for resuscitating children—now we know differently. The next step is to train pediatric medical care providers to assure kids get the lowest risk treatment that still does the job."

Researchers at Harbor-UCLA Medical Center in Los Angeles in cooperation with the emergency medical services agencies of Los Angeles and Orange counties conducted the study. They compared how two types of emergency breathing or respiration—bag-valve-mask ventilation (BVM) and BVM followed by endotracheal intubation (ETI)—affected survival and neurological outcomes, such as coma or mild to severe disability, of children who stopped breathing due to injury, choking or critical illness. BVM involves placing a mask on the face and squeezing a bag to push oxygen into the lungs. ETI involves inserting a plastic tube into the windpipe (trachea) to provide oxygen. Specially trained emergency medical providers often administer these procedures in paramedic ambulances or at emergency sites. Intubation is taught in 97 percent of paramedic training schools.

The children—ranging from infants to 12 years old or weighing less than 80 pounds—were assigned to receive either BVM or BVM followed by ETI. The study found no significant difference in survival or in achieving a good neurological outcome among children receiving either procedure.

Researchers questioned the widespread use of intubation for children because of its potentially deadly complications, such as misplacement or dislodgement of the tube, which can result in no oxygen getting to the child's lungs. They determined that the less risky BVM should be the only paramedic procedure used to keep children needing artificial respiration alive on their way to the hospital. If pediatric intubation is necessary, researchers recommended that it be performed in the more controlled hospital setting.

"This new evidence can help paramedics, physicians, nurses and others caring for children to make informed choices about which treatments work and to strengthen the overall practice of emergency care for critically ill or injured children," said Lisa A. Simpson, M.B., B.Ch., deputy director of AHRQ. "Translating this knowledge into practice can result in improved health services and enhanced quality of care for these children, while minimizing their health risks and saving lives."

This was the first controlled study comparing these treatments in either adults or children, even though BVM and ETI are widely used by paramedics. It also is the longest and largest controlled trial of treatments for children in a prehospital setting to date. More than 2,500 licensed paramedics in Los Angeles and Orange counties received pediatric airway management training prior to the study.

Marianne Gausche, M.D., is the lead author on the study titled "Out-of-Hospital Pediatric Endotracheal Intubation—The Effect on Survival and Neurological Outcome: A Controlled Clinical Trial."

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For more information, please contact: HRSA Press Office, (301) 443-3376; AHRQ Press Office, Ellen McGovern, (301) 427-1863.

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