Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial.
BACKGROUND
Endotracheal intubation (ETI) is widely used for airway management of children in the out-of-hospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome.


OBJECTIVE
To compare the survival and neurological outcomes of pediatric patients treated with bag-valve-mask ventilation (BVM) with those of patients treated with BVM followed by ETI.


METHODS
Controlled clinical trial, in which patients were assigned to interventions by calendar day from March 15, 1994, through January 1, 1997.


METHODS
Two large, urban, rapid-transport emergency medical services (EMS) systems.


METHODS
A total of 830 consecutive patients aged 12 years or younger or estimated to weigh less than 40 kg who required airway management; 820 were available for follow-up.


METHODS
Patients were assigned to receive either BVM (odd days; n = 410) or BVM followed by ETI (even days; n = 420).


METHODS
Survival to hospital discharge and neurological status at discharge from an acute care hospital compared by treatment group.


RESULTS
There was no significant difference in survival between the BVM group (123/404 [30%]) and the ETI group (110/416 [26%]) (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.61-1.11) or in the rate of achieving a good neurological outcome (BVM, 92/404 [23%] vs ETI, 85/416 [20%]) (OR, 0.87; 95% CI, 0.62-1.22).


CONCLUSIONS
These results indicate that the addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system.
Gausche
M
M
Department of Emergency Medicine, Harbor-UCLA Medical Center, and Harbor-UCLA Research and Education Institute, Torrance, Calif 90509, USA. mgausche@emedharbor.edu
Lewis
R J
RJ
Stratton
S J
SJ
Haynes
B E
BE
Gunter
C S
CS
Goodrich
S M
SM
Poore
P D
PD
McCollough
M D
MD
Henderson
D P
DP
Pratt
F D
FD
Seidel
J S
JS
D000488:Allied Health Personnel; D001499:Bayes Theorem; D001930:Brain Injuries / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002983:Clinical Competence; D004632:Emergency Medical Services; D006801:Humans; D007442:Intubation, Intratracheal; D009010:Monte Carlo Method; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States