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• W2111847833 abstract "We thank our French colleagues for their affirmative comments on our recent article on characteristics and outcome of prehospital paediatric tracheal intubation (TI) attended by anaesthesia-trained emergency physicians.1Eich C. Roessler M. Nemeth M. Russo S.G. Heuer J.F. Timmermann A. Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians.Resuscitation. 2009; 80: 1371-1377Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar In the majority of severely compromised ill or injured children, such as those with severe head injury, prolonged drowning, cardiopulmonary resuscitation, etc. there seems to be not much doubt that early TI is indicated. Although robust data on improvements of survival or neurological outcomes are sparse (as for other emergency medical interventions, e.g. iv-adrenaline in cardiac arrest) these children would be intubated in hospital as soon as possible.2ILCOR Paediatric basic and advanced life support.Resuscitation. 2005; 67: 271-303Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar, 3Biarent D. Bingham R. Richmond S. et al.European Resuscitation Council guidelines for resuscitation 2005. Section 6. Paediatric life support.Resuscitation. 2005; 67: S97-S133Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar Thus, above all, the question is not if but rather when, where and by whom TI should be best performed. Gausche and colleagues deserve merits for having performed a large randomized controlled study on prehospital intubation of children whose results did not favour prehospital TI over bag-mask-ventilation (BMV).4Gausche M. Lewis R.J. Stratton S.J. et al.Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial.JAMA. 2000; 283: 783-790Crossref PubMed Scopus (700) Google Scholar However, it should be noted that the TI success rates in this paramedic-based study were only 56–67% (lower in children below 3 years of age), and that the overall outcomes were poor (BMV vs. TI: survival 30 resp. 26%, good neurological outcome 23% vs. 20%). Furthermore, the study setting was notably urban (Orange County) with relatively short delays to hospital admission. These aspects represent important limitations on the multiple conclusions commonly drawn from this landmark study. Paediatric emergencies are rather heterogeneous—as are the characteristics of emergency medical services at different locations.5Eich C. Russo S.G. Heuer J.F. et al.Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians.Resuscitation. 2009; 80: 888-892Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar In light of the sparse scientific evidence and based on the at times considerable infrastructural differences, it also appears to be a matter of emergency response philosophy as to how much and what quality of medical care should be brought forward toward the prehospital setting.6Timmermann A. Russo S.G. Hollmann M.W. Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept.Curr Opin Anaesthesiol. 2008; 21: 222-227Crossref PubMed Scopus (77) Google Scholar With regard to prehospital paediatric TI the known facts are: (1) it is a potentially difficult procedure that requires complex psychomotor skills and that can cause secondary complications7Meyer P.G. Orliaguet G. Blanot S. et al.Complications of emergency tracheal intubation in severely head-injured children.Pediatric Anesthesia. 2000; 10: 253-260Crossref PubMed Scopus (38) Google Scholar; (2) early TI may be beneficial in certain circumstances, e.g. severe head injury, prolonged drowning, CPR, etc. and is therefore the accepted standard for securing a definitive airway in children,2ILCOR Paediatric basic and advanced life support.Resuscitation. 2005; 67: 271-303Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar, 3Biarent D. Bingham R. Richmond S. et al.European Resuscitation Council guidelines for resuscitation 2005. Section 6. Paediatric life support.Resuscitation. 2005; 67: S97-S133Abstract Full Text Full Text PDF PubMed Scopus (210) Google Scholar and (3) skilled and experienced providers perform prehospital TI efficiently and safe.1Eich C. Roessler M. Nemeth M. Russo S.G. Heuer J.F. Timmermann A. Characteristics and outcome of prehospital paediatric tracheal intubation attended by anaesthesia-trained emergency physicians.Resuscitation. 2009; 80: 1371-1377Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar, 7Meyer P.G. Orliaguet G. Blanot S. et al.Complications of emergency tracheal intubation in severely head-injured children.Pediatric Anesthesia. 2000; 10: 253-260Crossref PubMed Scopus (38) Google Scholar Overall, the available data indicate that prehospital TI in children should neither be uncritically advocated nor globally condemned but rather be carefully adopted with individual consideration and the best clinical care. We therefore fully agree with Martinon and colleagues that guidelines on paediatric emergency airway management must acknowledge the wide spectrum of local infrastructures in terms of staffing, clinical expertise, medical equipment, time delay to hospital admission, etc. In our view, this can only be achieved if international guidelines are defined as interventional corridors in which local concepts of care are incorporated in. In terms of prehospital paediatric airway management, this corridor should include a range of potential indications for early TI as well as a range of techniques such as BMV, oro- and nasopharyngeal airways, supraglottic airway devices (e.g. laryngeal mask) and endotracheal tube. None." @default.
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• W2111847833 date "2010-05-01" @default.
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• W2111847833 title "Reply to Letter: Paediatric tracheal prehospital intubation—What makes different our practice across the Ocean?" @default.
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