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July 13, 1984

Use of Esophageal Gastric Tube Airway-Reply

Author Affiliations

University of California, San Francisco San Francisco General Hospital

JAMA. 1984;252(2):209-210. doi:10.1001/jama.1984.03350020018014

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In Reply.—  We thank each of the authors for their thoughtful comments. Dr Mangold has succinctly reiterated our observations concerning the functional inadequacy of the EGTA. We commend his community for the establishment of endotracheal intubation training for paramedical personnel.We are unaware of any data that support Mr Fluck's contention that ventilation-perfusion matching improves spontaneously as cardiac resuscitation proceeds over time. In full cardiac arrest, cardiac output and perfusion deteriorate in a time-dependent fashion. Improvement in ventilation during cardiopulmonary resuscitation is a concept that may be supported in surfactant-deficient neonates or victims of submersion incidents but cannot be supported in routine resuscitations, wherein atelectasis plays an exceedingly minor role. Certainly, it cannot account for significant improvement over a five-minute period following a 20-minute resuscitation. As we noted in our discussion, no conclusion can be drawn from patients who cannot be adequately oxygenated or ventilated following endotracheal intubation, since they