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Letters |

Prehospital Airway Management for Out-of-Hospital Cardiac Arrest

Tatsuya Norii, MD; Tetsuo Hatanaka, MD, PhD
JAMA. 2013;309(18):1888-1890. doi:10.1001/jama.2013.3104.
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To the Editor: We are concerned that the study by Dr Hasegawa and colleagues1 on prehospital advanced airway management in patients with OHCA has not accounted for one important selection bias or confounding by indication. There are significant differences in the practice of paramedics in Japan compared with the United States, including the indication for advanced airway devices.

The Japanese national protocol for resuscitation by emergency life-saving technicians2,3 states that bag-valve-mask ventilation is to be used as the first choice for management of the airway and ventilation, and advanced airway devices (including a supraglottic airway device or endotracheal tube) should be considered only when the patient cannot be adequately ventilated or a long transportation time is expected. Consequently, patients with airways that are difficult to ventilate, or those for whom a long transportation time is expected, are more likely to have advanced airway devices inserted at the scene, thus leading to potential selection bias.

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May 8, 2013
Kohei Hasegawa, MD, MPH; Atsushi Hiraide, MD, PhD; David F. M. Brown, MD
JAMA. 2013;309(18):1888-1890. doi:10.1001/jama.2013.3107.
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