20 February 2000

Safer pediatric resuscitation

by Kate Melville

Every parent's nightmare is having a being involved in a situation that requires a paramedic to resuscitate his or her child.

Resuscitation is generally done by paramedics in one of two ways:

� Endotracheal intubation (ETI) - inserting a plastic tube into the windpipe (trachea) to provide oxygen � Bag-valve-mask ventilation (BVM) - placing a mask on the face and squeezing a bag to push oxygen into the lungs

(Mouth-to-mouth resuscitation is only used when these more advanced techniques are not possible due to special circumstances.)

In the US a study of these two techniques by the Health Resources and Services Administration's Maternal and Child Health Bureau and Agency for Healthcare Research and Quality has just been published. In the February issue of the Journal of the American Medical Association, after reviewing 830 cases over a 3-year period, their finding is that paramedic intubation should be stopped and replaced with the far more simple BVM method.

Intubation is a risky procedure according to Dr. Claude Fox, one of the researchers. "Intubation has been an accepted procedure for resuscitating children--now we know differently. The next step is to train pediatric medical care providers to assure kids get the lowest risk treatment that still does the job."

This project was carried out between researchers at Harbor-UCLA Medical Center in Los Angeles who worked in tandem with the emergency medical services agencies in Los Angeles and Orange counties.

Comparisons were conducted as to how BVM and BVM followed by ETI, influenced patients' survival and neurological outcomes.

The results showed no major difference in survival or neurological outcomes among children receiving either procedure. However, researchers did question the widespread use of intubation for children because of its potentially deadly complications. Given the results they recommended that BVM should be the only paramedic procedure used for children, as it is much simpler. If intubation is required then where possible, researchers proposed that it only be carried out in a hospital.

The study was the longest and largest controlled trial of treatments for children in a pre-hospital setting in the United Sates to date and should have an international impact on emergency pediatric resuscitation.