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To the Editor:—
Dr. Carmichael's sketch with brief text in the Correspondence section of The Journal (169:176 [Jan. 10] 1959) has come to my attention. Since most cardiac standstills occur from myocardial failure due to rapidly progressive anoxia—stagnant, anemic, or histotoxic anoxia or an unfortunate combination of these—it might be well to dwell briefly on the vital issue of respiratory support. While Dr. Carmichael admits the proper sequence of events, he unhappily reverses this sequence at the bottom of his line cut, by placing "knife" over "airway." The need for respiratory support apparently is to be covered by providing a plastic airway, tacitly by-passing the issue altogether. What surgeon would think of opening the chest without the protection of an endotracheal tube, providing direct insufflation of the lungs with oxygen or air? Yet the patient about to die from hypoxia is expected to get along without this support. To
Flagg PJ. CARDIAC EMERGENCY. JAMA. 1959;169(9):984. doi:10.1001/jama.1959.03000260082023
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