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October 3, 1986

Cardiopulmonary Resuscitation

Author Affiliations

Southfield, Mich

JAMA. 1986;256(13):1722. doi:10.1001/jama.1986.03380130050012

To the Editor.—  The publication of the "Standards and Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC)" lucidly explains and illustrates the advances in this area.1 It was encouraging to note that the technique of pediatric intraosseous infusion is discussed, since this method of gaining vascular access has often been overlooked.2,3 Intratibial access can be obtained by use of a spinal needle with a stylet; however, it is much safer to use a proper bone marrow needle for any form of intraosseous infusion. Removing a plug of cortical bone rather than driving it inward by use of a trephinated tip reduces the threat of embolism.4 Physicians often fail to consider the intrasternal route, which was safely used by so many medics and paramedics during and immediately following World War II, and which is particularly effective in the treatment of adults when the intravenous route is