Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome - A controlled clinical trial

Context Endotracheal intubation (ETI) is widely used for airway management of children in the out-of-hospital setting, despite a lack of controlled tr ials demonstrating a positive effect on survival or neurological outcome. Objective To compare the survival and neurological outcomes of pediatric pa tients treated with bag-valve-mask ventilation (BVM) with those of patients treated with BVM followed by ETI. Design Controlled clinical trial, in which patients were assigned to interv entions by calendar day from March 15, 1994, through January 1, 1997. Setting Two large, urban, rapid-transport emergency medical services (EMS) systems. Participants A total of 830 consecutive patients aged 12 years or younger o r estimated to weigh less than 40 kg who required airway management; 820 we re available for follow-up. Interventions Patients were assigned to receive either BVM (odd days; n = 4 10) or BVM followed by ETI (even days; n = 420). Main Outcome Measures Survival to hospital discharge and neurological statu s at discharge from an acute care hospital compared by treatment group. Results There was no significant difference in survival between the BVM gro up (123/ 404 [30%]) and the ETI group (110/416 [26%]) (odds ratio [OR], 0.8 2; 95% confidence interval [CI], 0.61-1.11) or in the rate of achieving a g ood neurological outcome (BVM, 92/404 [23%] vs ETI, 85/416 [20%]) (OR, 0.87 ; 95% CI, 0.62-1.22). Conclusion 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.