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May 26, 1993

Cardiopulmonary Resuscitation-Reply

Author Affiliations

Vanderbilt University Medical Center Nashville, Tenn American Heart Association
University of Connecticut Health Center Farmington American Heart Association

JAMA. 1993;269(20):2626-2627. doi:10.1001/jama.1993.03500200039021

In Reply.  —The phrase from the 1992 PALS guidelines, "This technique enables effective support of oxygenation...," is challenged as unreferenced and inaccurate. However, Drs Burke and Mellick have omitted the subsequent qualifying phrase, "although carbon dioxide elimination may be suboptimal."The statement is referenced at the beginning of the paragraph.1 In a study of dogs weighing 21 to 30 kg, the PaO2 was consistently maintained above 130 mm Hg during 30 minutes of manual ventilation via percutaneous needle cricothyrotomy.1 The paucity of pediatric data is acknowledged in the guidelines: "Percutaneous needle cricothyrotomy has only been effective in small animals. [reference]. However, only anecdotal reports of this method of ventilation in children have been published so further evaluation is needed."The two clinical review articles cited by Burke and Mellick confirm that needle cricothyrotomy may not support oxygenation and ventilation in adults. As Yealy et al observed, "The