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June 7, 2000

Out-of-Hospital Endotracheal Intubation of Children

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(21):2790-2792. doi:10.1001/jama.283.21.2787

To the Editor: There are 2 significant flaws in the study reported by Dr Gausche and colleagues.1 First, the investigators failed to equip paramedics to intubate those children who would be most likely to benefit from the procedure. Anatomic factors mandate that emergency pediatric intubation be accomplished via the oral route, and failure to use appropriate medications reduces the likelihood of successful intubation. Without anesthetics or muscle relaxants, only very young or moribund patients can reliably be intubated orally.2 Gausche et al note their disappointing 57% success rate, but do not describe which children underwent successful intubation. It seems likely that those children who were flaccid as a result of lethal illness or injury were most likely to have had endotracheal tubes placed successfully.

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