Study Changes Paramedics’ Methods for Treating Gravely Injured Children

A three-year study involving 830 gravely injured children in Orange and Los Angeles counties is challenging the conventional wisdom on a life-or-death issue.

It found that inserting a tube directly into the airway of a child whose breathing had slowed or stopped worked no better than manually forcing air into the lungs by squeezing a bag attached to an oxygen mask.

Emergency personnel have been trained to intubate children as a matter of routine. The study, to be published today in the Journal of the American Medical Assn., has already changed rescue practices in Orange County and Los Angeles County, health officials said.

The study, said to be the largest of its kind, was led by Dr. Marianne Gausche, an emergency medicine specialist at the Harbor-UCLA Medical Center in Torrance.

“It’s better if paramedics use the safe and simple method of bag-valve-mask ventilation while rushing the child to the hospital than if they try the relatively risky process of intubation,” she said in a statement.

The researchers compared 410 injured children, ages 12 and under, who were resuscitated with the bag-and-mask method to 430 who underwent intubation from 1994 to 1997.

Among the injuries were head traumas, drownings and asthma attacks. The groups had essentially the same rates of survival and neurological impairment for nearly all injuries. Kids who were choking on something were more likely to survive with the bag-and-mask approach.