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Airway Management During Active Compression-Decompression CPR-Reply

Ian G. Stiell, MD, MSc, FRCPC; Paul C. Hébert, MD, MHSc, FRCPC; George A. Wells, PhD; Andreas Laupacis, MD, MSc, FRCPC
JAMA. 1996;276(6):449. doi:10.1001/jama.1996.03540060025018.
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In Reply.  —Mr Rottenberg is concerned that our study may have been biased against ACD CPR because the out-of-hospital patients were not intubated until they reached the hospital. We would like to reassure Rottenberg that his concerns are unfounded for 2 reasons. First, all 773 patients from the in-hospital stratum of the study were intubated very early in their resuscitation. Second, all 1011 patients from the out-of-hospital stratum, regardless of whether they were in the ACD CPR or the standard CPR group, had exactly the same airway and ventilation management. This consisted of CPR by 2 professional rescuers who used standard oropharyngeal airways and bag-valve-mask ventilation prior to arrival at the hospital. All out-of-hospital rescuers were also capable of performing defibrillation.Rottenberg may have overlooked the fact that in many US and most Canadian jurisdictions, prehospital cardiac arrest patients are not intubated until they arrive at the hospital. Consequently, the out-of-hospital arm


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