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Cardiopulmonary Resuscitation

Gregory Burke, MD; Larry Mellick, MD
JAMA. 1993;269(20):2626. doi:10.1001/jama.1993.03500200039020.
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To the Editor.  —We would like to advise you of an inappropriate recommendation concerning management of the pediatric airway. During a discussion of percutaneous needle cricothyrotomy for patients with severe facial trauma in the section "Miscellaneous Adjuncts to Airway Ventilation,"1 the use of a largebore (ie, 14-gauge) over-the-needle catheter attached to a standard (3-mm) endotracheal tube adapter and a hand resuscitation bag is recommended. There is an unreferenced statement, "This technique enables effective support of oxgenation."We believe that there is no evidence to support the effectiveness of this recommendation. In fact, there is significant published material suggesting that this technique will not support oxygenation and ventilation. In 1988, Yealy et al2 demonstrated that ventilation through a catheter with a bagvalve setup is not effective unless one is using a minimal tube size of 3.5-mm internal diameter (ID).2 Furthermore, these authors confirmed that if one uses a


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