***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: STUDY OBJECTIVE To compare nasotracheal intubation ( NTI ) to neuromuscular blockade-assisted oral intubation ( NMB-assisted oral intubation ) in the prehospital care of injured patients . DESIGN Prospect i ve , r and omized study conducted over 21 months . SETTING A university hospital-sponsored helicopter service . PARTICIPANTS Consecutive adult ( more than 12 years old ) injured patients at the accident scene with an initial Glasgow Coma Scale of 8 or less in whom the airway was not managed immediately by unrelaxed oral intubation or cricothyrotomy .  Subjects were r and omized by 24-hour time blocks into NTI or NMB-assisted oral intubation treatment groups . Forty-four were entered into the NTI group ( 39 r and omized , two crossed over to NMB-assisted oral intubation ) , and 33 were entered into the NMB-assisted oral intubation group ( 38 r and omized , seven crossed over to NTI ) . INTERVENTIONS NMB-assisted oral intubation ( succinylcholine 1.5 mg/kg IV ) or NTI was carried out according to st and ard protocol s. RESULTS The success rate for NTI was 79.5 % ( 35 of 44 ) and was similar to that of NMB-assisted oral intubation , 75.8 % ( 25 of 33 ; chi 2 = .16 ; P = .69 ) . There were no significant differences between the NTI and the NMB-assisted oral intubation groups with regard to sex , age , outcome , and Glasgow Coma Scale . For those patients in whom the initial technique was successful , NTI was significantly quicker than NMB-assisted oral intubation ( mean time of NTI , 2.9 minutes ; mean time of NMB-assisted oral intubation , 5.9 minutes ; Mann-Whitney U , 168.0 ; P < .01 ) . CONCLUSION In the prehospital management of severely injured patients , there is no significant difference between NMB-assisted oral intubation and NTI in the rate at which endotracheal intubation is achieved . However , practitioners may prefer NTI because it requires significantly less time to perform than NMB-assisted oral intubation OBJECTIVE : To test the hypothesis that limited paramedic advanced life support skills afford no advantage in survival from cardiac arrest when compared with non-paramedic ambulance crews equipped with defibrillators in an urban environment ; and to investigate whether separate response units delayed on scene times . METHODS : A prospect i ve , observational study was conducted over 17 consecutive months on all adult patients brought to the accident and emergency ( A&E ) department of Glasgow Royal Infirmary having suffered an out of hospital cardiac arrest of cardiac aetiology . The main interventions were byst and er cardiopulmonary resuscitation ( CPR ) and limited advance life support skills . MAIN OUTCOME MEASURES : Return of spontaneous circulation , survival to admission , and discharge . RESULTS : Of 240 patients brought to the A&E department , 19 had no clear record of whether a paramedic was or was not involved and so were excluded . There was no difference in survival between the two groups , although a trend to admission favoured non-paramedics . Paramedics spent much longer at the scene ( P < 0.0001 ) . Witnessed arrests ( P = 0.01 ) , early byst and er CPR ( P = 0.12 ) , shockable rhythms ( P = 0.003 ) , and defibrillation ( P < 0.0001 ) were associated with better survival . Intubation and at scene times were not associated with better survival . Delayed second response units did not prolong at scene times . CONCLUSIONS : The interventions of greatest benefit in out of hospital cardiac arrest are basic life support and defibrillation . Additional skills are of question able benefit and may detract from those of greatest benefit BACKGROUND Prehospital intubation and airway control is routinely performed by paramedics in critically injured patients . Despite the advantages provided by this procedure , numerous potential risks exist when this is performed in the field . We review ed the outcome of patients with severe head injury , to determine whether prehospital intubation is associated with an improved outcome . METHODS A retrospective review of registry data of patients admitted to an urban trauma center with severe head injury ( field Glasgow Coma Scale score of < or = 8 and head Abbreviated Injury Scale score of > or =3 ) was performed . Patients were stratified by methods of airway control performed by prehospital personnel : not intubated , intubated , or unsuccessful intubation .  Mortality was determined for each group . To control for significant variables between these population s , matching and multivariate analysis were performed . RESULTS Patients requiring prehospital intubation or in whom intubation was attempted had an increased mortality ( 81 % and 77 % , respectively ) when compared with nonintubated patients ( 43 % ) . The mortality for patients who had prehospital intubation performed did not demonstrate an improved survival using matching . In fact , intubated patients had a significantly higher relative risk ( RR ) of mortality when compared with nonintubation ( RR = 1.74,p < 0.001 ) and unsuccessful intubation patients ( RR = 1.53 , p = 0.008 ) CONCLUSION For patients with severe head injury , prehospital intubation did not demonstrate an improvement in survival . Further prospect i ve r and omized trials are necessary to confirm these results CONTEXT Endotracheal intubation ( ETI ) is widely used for airway management of children in the out-of-hospital setting , despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome . OBJECTIVE To compare the survival and neurological outcomes of pediatric patients treated with bag-valve-mask ventilation ( BVM )  with those of patients treated with BVM followed by ETI .  DESIGN Controlled clinical trial , in which patients were assigned to interventions by calendar day from March 15 , 1994 , through January 1 , 1997 . SETTING Two large , urban , rapid-transport emergency medical services ( EMS ) systems . PARTICIPANTS A total of 830 consecutive patients aged 12 years or younger or estimated to weigh less than 40 kg who required airway management ; 820 were available for follow-up . INTERVENTIONS Patients were assigned to receive either BVM ( odd days ; n = 410 ) or BVM followed by ETI ( even days ; n = 420 ) . MAIN OUTCOME MEASURES Survival to hospital discharge and neurological status at discharge from an acute care hospital compared by treatment group . RESULTS There was no significant difference in survival between the BVM group ( 123/404 [ 30 % ] ) and the ETI group ( 110/416 [ 26 % ] ) ( odds ratio [ OR ] , 0.82 ; 95 % confidence interval [ CI ] , 0.61 - 1.11 ) or in the rate of achieving a good neurological outcome  ( BVM , 92/404 [ 23 % ] vs ETI , 85/416 [ 20 % ] ) ( OR , 0.87 ; 95 % CI , 0.62 - 1.22 ) . CONCLUSION These results indicate that the addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system OBJECTIVE Determine whether prehospital advanced life support ( ALS ) improves the survival of major trauma patients and whether it is associated with longer on-scene times . METHODS A 36-month retrospective study of all major trauma patients who received either prehospital bag-valve-mask ( BVM ) or endotracheal intubation ( ETI ) and were transported by paramedics to our Level I trauma center . Logistic regression analysis determined the association of prehospital ALS with patient survival . RESULTS Of 9,451 major trauma patients , 496 ( 5.3 % ) had either BVM or ETI . Eighty-one percent received BVM , with a mean Injury Severity Score of 29 and a mortality rate of 67 % ; 93 patients ( 19 % ) underwent successful ETI , with a mean Injury Severity Score of 35 and a mortality rate of 93 % . Adjusted survival for patients who had BVM was 5.3 times more likely than for patients who had ETI ( 95 % confidence interval , 2.3 - 14.2 , p = 0.00 ) . Survival among patients who received intravenous fluids was 3.9 times more likely than those who did not ( p = not significant ) . Average on-scene times for patients who had ETI or intravenous fluids were not significantly longer than those who had BVM or no intravenous fluids . CONCLUSION ALS procedures can be performed by paramedics on major trauma patients without prolonging on-scene time , but they do not seem to improve survival The aim of our prospect i ve study was to evaluate the effects of a st and ardized mega-code and arrhythmia training upon process elements of quality of pre-hospital advanced cardiac life support provided by a physician-staffed mobile intensive care unit . In 145 cases of adult cardiac arrest due to cardiac aetiology , time intervals from arrival of the mobile intensive care unit at the patient 's side until first ECG diagnosis , first  defibrillation  ,  endotracheal intubation , and first  epinephrine administration were measured with on-line tape recording , prior to , and following a st and ardized 8-h arrhythmia and mega-code training . Following the training , patients with asystole or pulseless electrical activity were intubated 1.1 min earlier ( P = 0.03 ) , and received epinephrine 1.3 min earlier ( P = 0.01 ) than prior to the training . There were no significant differences in time intervals concerning management of ventricular fibrillation or tachycardia . Neither admission nor discharge rates differed significantly before and after the training . Thus , practical training including rhythm analysis and mega-code session improved the performance of our mobile intensive care unit in cases of asystole and pulseless electrical activity , and , hence , process elements of quality A prospect i ve study compared the respiratory effectiveness of the endotracheal tube ( ET ) with that of the esophageal gastric tube airway ( EGTA ) for victims of nontraumatic cardiac arrest in the pre-hospital setting .  Arterial blood gases were obtained within 3 minutes of hospital arrival , and survival ( defined as discharge from the hospital ) was determined . During EGTA ventilation , mean pH was 7.12 + /- 0.2 , mean P02 was 77 + /- 92 mm Hg , and mean PC02 was 78.2 + /- 42.9 mm Hg ; the survival rate was 4.5 % . During ET ventilation , mean pH was 7.34 + /- 0.2 , mean P02 was 265 + /- 151 mm Hg , mean PC02 was 35 + /- 20.5 mm Hg ; the survival rate was 7 % . The authors conclude that endotracheal intubation remains the procedure of choice for airway management in the victim of cardiopulmonary arrest We evaluated the efficacy of the esophageal airway ( EA ) by prospect ively r and omizing 175 prehospital cardiopulmonary arrest patients to receive either an esophageal gastric tube airway ( EGTA ) or an endotracheal tube ( ET ) . If attempts with the initial airway failed , the alternate airway was attempted . The cost of training paramedics in EA use was considerably less than the ET ( $ 80 vs $ 1,000 ) . Survival to the emergency room , to hospitalization and to discharge in ET and EGTA groups were 64.4 percent , 25.6 percent , 11.1 percent , and 54.1 percent , 27.1 percent , 12.9 percent , respectively -- differences not statistically significant . The incidence of neurologic residual  ( ET 50 percent , EGTA 36.4 percent ) and congestive heart failure  ( ET 40 percent , EGTA 45.5 percent ) in surviving ET and EGTA patients did not differ ( NS ) . An additional 125 consecutive patients with only the opportunity to receive an EA  were also evaluated and did not differ in mortality , neurologic residual , or congestive heart failure from ET patients . We conclude that the EA is a satisfactory alternative to the ET for short-term prehospital use in cardiopulmonary arrest patients STUDY OBJECTIVE We sought to determine whether the interval between the arrival of  first responder/defibrillators and paramedic advanced life support ( ALS ) interventions is associated with outcome . METHODS We carried out a prospect i ve observational study of adults in out-of-hospital cardiac arrest treated by both first responders and paramedics in an urban emergency medical services system between July 15 , 1992 , and May 27 , 1993 ( N = 544 ) . RESULTS The gap between first-responder and medic arrival was short ( 3.2 minutes ) ; medics arrived before first-responder shock in 22 % of ventricular fibrillation ( VF ) cases . Just 10 % of patients has a pulse when medics arrived , but the presence of pulse on medic arrival was a powerful predictor of hospital discharge ( odds ratio [ OR ] , 20.5 ; sensitivity , 39 % ; specificity , 98 % ; positive predictive value , 55 % ; negative predictive value , 97 % ) or a Cerebr 
    Output:
    
In non-traumatic cardiac arrest , it is unlikely that intubation carries the same life saving benefit as early defibrillation and byst and er cardiopulmonary resuscitation ( CPR ) .