Correspondence Table Time to and success of intubation Device Time to intubation, s BERCI GVL McGrath MIL 23.8 ± 14.5 22.5 ± 11.4 17.5 ± 5.7 35.6 ± 19.5 Tracheal intubation attempts First (%) Second (%) Third (%) 93.6% 97.6% 100% 52.4% 100% 100% 100% 69.0% 100% 100% 100% 77.8 Failed (%) 0.0% 0.0% 0.0% 22.2% cardiopulmonary and cerebral perfusion pressure [1]. These guidelines also suggest that the rescuer should secure the airway without interrupting CC [1,2]. The criterion standard for securing the airway is endotracheal intubation, which allows for continuous ventilation of the patient without interrupting CC and allows the use of positive pressure in the airways. However, Endotracheal Intubation (ETI) during CPR while using the Miller laryngoscope (MIL) is a difficult skill, even for professionals [3-5]. In such situations video laryngoscopes, which facilitate observation of the vocal cords and thus ease the process of intubation can be beneficial. We hypothesized that video laryngoscopes are beneficial for infant intubation manikins while performing CPR. After Institutional Review Board of International Institute of Rescue Research and Education (Warsaw, Poland; prot. no.:12.2014.12.45) approval and with written, voluntary informed consent of 126 paramedics, each with minimum 1 year of work experience in emergency medical service, and with approximately 100 direct laryngoscopic intubations' worth of experience in patients but no experience with video laryngoscopy participated in this study. One hundred twenty-nine participants (53 female, 41.1%), mean age was 31.03 ± 8.55 years, and mean work experience was 8.94 ± 7.22 years. This was randomized, crossover controlled trial. We used the Laerdal ALS Baby training mannequin (Lærdal, Norway), which is designed to be an accurate representation of a 3-month-old infant. Chest compression was performed by an independent instructor using the 2-hand technique. Four tracheal intubation devices were used: The BerciKaplan infant DCI (BERCI) (KARL STORZ GmbH & Co KG, Tuttlingen, Germany), the GlideScope GVL (GVL) blade size 2 (Verathon Medical, Bothell, WA), the McGrath Series 5 (McGrath) (Aircraft Medical, San Diego, CA), and the MIL with blade size 1 (Mercury Medical, Clearwater, FL). Study enrollment occurred from September 2014 to October 2014. After voluntary written informed consent, participants participated in a 60-minute course of ETI. The order of intubation using the 4 ETI devices during CC was randomized for each participant to minimize any learning effects. The randomization procedure came from a computer program (Research Randomizer [www.randomizer.org]; Figure: Supplementary data). After each device, participants took a 20-minute rest and then performed ETI using the next device. The participants were not allowed to watch each other to avoid learning through observation. The primary end point of the study was defined as the time from the insertion of a device blade to the patient's mouth to the first manual ventilation of the mannequin's lungs, whereas the secondary end point was the success rate of blind tracheal intubation. If the examinee failed at all attempts, the case was excluded from the time calculations. To assess subjective opinions about the difficulty of the procedure, participants were asked to rate it on a visual analogue scale with a score from 1 (very easy) to 5 (very difficult). Quantitative data are presented as mean and SD. The primary study end point was the time to first effective ventilation, which was achieved fastest when using McGrath (17.5 ± 5.7 seconds) and was statistically significantly slower with GVL (22.5 seconds, P = .023) as well as BERCI (23.8 seconds, P = .029) and MIL (35.6 seconds, P b .001; Table). The success rate after first intubation attempts using ETI devices varied and amounted to 93.6% vs 97.6% vs 100% vs 52.4% (BERCI, GVL, McGrath, and MIL, respectively). There was a 461 statistically significant difference in the overall success rate of the intubation between MIL and BERCI (P b .001) as well as GVL (P b .001) and McGrath (P b .001). The visual analogue scale score was 1.9 points in the case of McGrath, which was lower in relation to the other ETI devices: BERCI, 3.2 points (P = .004); GVL, 3.0 points (P = .003); and MIL, 4.1 points (P b .001). We conclude that video laryngoscopes may be useful in rapid intubation of pediatric patients resuscitation with uninterrupted CCs. More studies are required to confirm these results. Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ajem.2014.11.039. Łukasz Szarpak, MSc, EMT-P Department of Cardiosurgery and Transplantology Institute of Cardiology, Warsaw, Poland Andrzej Kurowski, PhD, MD Department of Anesthesiology, Institute of Cardiology, Warsaw, Poland Zenon Truszewski, PhD, MD Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland Łukasz Czyżewski Department of Anesthesiology, Institute of Cardiology, Warsaw, Poland Department of Nephrologic Nursing, Medical University of Warsaw, Warsaw, Poland Corresponding author. Department of Nephrologic Nursing, Medical University of Warsaw 61 Zwirki Wigury Street 02-091 Warsaw, Poland E-mail address: RN.czyzewski@gmail.com http://dx.doi.org/10.1016/j.ajem.2014.11.039 References [1] Biarent D, Bingham R, Eich C, López-Herce J, Maconochie I, Rodríguez-Núñez A, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation 2010;81(10):1364–88. http://dx.doi.org/10.1016/j.resuscitation.2010.08.012. [2] Richmond S, Wyllie J. European Resuscitation Council Guidelines for Resuscitation 2010 Section 7. Resuscitation of babies at birth. Resuscitation 2010;81(10): 1389–99. http://dx.doi.org/10.1016/j.resuscitation.2010.08.018. [3] Szarpak L. Are we prepared for the newborn resuscitation? Mil Pharm Med 2013;6 (2):47–54. [4] Kaufmann J, Laschat M, Engelhardt T, Hellmich M, Wappler F. Tracheal intubation with the Bonfils fiberscope in the difficult pediatric airway: a comparison with fiberoptic intubation. Paediatr Anaesth 2014. http://dx.doi.org/10.1111/pan.12523 [Epub ahead of print]. [5] Rodríguez-Núñez A, Moure-González J, Rodríguez-Blanco S, Oulego-Erroz I, Rodríguez-Rivas P, Cortiñas-Díaz J. Tracheal intubation of pediatric manikins during ongoing chest compressions. Does Glidescope® video laryngoscope improve pediatric residents' performance? Eur J Pediatr 2014;173(10):1387–90. http://dx.doi.org/ 10.1007/s00431-014-2329-z. Adverse effects of energy drinks To the Editor, Energy drinks are very popular among young people, and these drinks are marketed to college students, athletes, and active individuals. Energy drinks typically contain high levels of caffeine, sugar, and other ingredients such as taurine, B-complex vitamins, ginseng, and guarana seed extract [1-3]. To the best of our knowledge, the first case of ischemic stroke after intake of energy drink was reported in 2013 by us. In that case, we reported a 37-year-old patient presenting with epileptic 462 Correspondence seizure and ischemic stroke [2]. In our other recent report is a unique case of a patient who had transient ischemic attack related to intake of an energy drink. The patient had drunk 2 energy drinks (Redbull, 250 mL, Red Bull GmbH, Fuschl am See, Austria), while he was working in the emergency department [4]. Recently, Bernstein et al [5] found that greater consumption of sugar-sweetened and low-energy sodas was associated with a higher risk of stroke. In this study, the authors say that participants who left excessive items blank on their baseline food-frequency questionnaire and those who reported implausibly lowor high-energy intakes were excluded. In addition, they included only low-energy cola with caffeine (eg, Diet Coke and Tab with caffeine), low-energy cola without caffeine (eg, Pepsi Free), other low-energy carbonated beverages (eg, Diet 7Up, Fresca, Diet Mountain Dew, and diet ginger ale), sugar-sweetened cola with caffeine (eg, Coke and Pepsi), sugar-sweetened cola without caffeine (eg, caffeine-free Coke and caffeine-free Pepsi), and other carbonated beverages with sugar (eg, 7Up, Mountain Dew, Surge, and Dr Pepper) [5]. But they did not include energy drinks. Cheungpasitporn et al [6] reported that sweetened beverage consumption is positively associated with the risk of stroke. They included only patients with consuming either sugar-sweetened or artificially sweetened soda [6]. These beverages are not energy drinks. Endothelial cell function has been commonly accepted that endothelial cell function is closely related to cardiovascular risk, with impairment being involved in the pathogenesis of atherosclerosis and cardiovascular disease [7]. Endothelial dysfunction may play a role in morbidity with concomitant energy drink intake and exercise [8]. Energy drinks contain high levels of caffeine, sugar, and other ingredients (taurine, B-complex vitamins, ginseng, and guarana seed extract). Both of our previous reports are associated with energy drinks. Therefore, we thought that intake of energy drinks may cause epileptic seizure, ischemic stroke, or transient ischemic attack. The growing literature sheds light on acute health problems associated with these products. Because energy drinks very popular among young individuals, we want to attract attention to adverse effects of energy drinks. [6] Cheungpasitporn W, Thongprayoon C, O'Corragain OA, Edmonds PJ, Kittanamongkolchai W, Erickson SB. Associations of sugar-sweetened and artificially sweetened soda with chronic kidney disease: a systematic review and meta-analysis. Nephrology (Carlton) 2014;19(12):791–7. [7] Buscemi S, Cosentino L, Rosafio G, et al. Effects of hypocaloric diets with different glycemic indexes on endothelial function and glycemic variability in overweight and in obese adult patients at increased cardiovascular risk. Clin Nutr 2012;32:346–52. [8] Higgins JP. Endothelial function acutely worse after drinking energy beverage. Int J Cardiol 2013;168(2):e47–9. Ayhan Saritas, MD Duzce University School of Medicine, Department of Emergency Medicine, Duzce, Turkey Corresponding author. Duzce University, School of Medicine Department of Emergency Medicine 81620, Duzce- Turkey Tel.:+90 380 5421390 / 5850; fax:+90 380 5421387 E-mail address: a_saritas_@hotmail.com Charat Thongprayoon, MD Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA Suber Dikici, MD Duzce University School of Medicine, Department of Neurology, Duzce, Turkey Harun Gunes, MD Duzce University School of Medicine, Department of Emergency Medicine, Duzce, Turkey Transient ischemic attack related to sweetened beverage consumption☆,☆☆ To the Editor, We thank Dikici et al [1] for their interesting case study, “Does an energy drink cause a transient ischemic attack?” published in The American Journal of Emergency Medicine. The authors reported a 26-year-old patient presenting with transient ischemic attack. From the fact that the patient had history of energy drink consumption and extensive work-ups were negative, the author concluded that energy drink caused transient ischemic attack. This is a very interesting finding. However, we are wondering if the authors should also report the status of sweetened beverage consumption in this case. Recently, sweetened beverage consumption has been found to be independently associated with ischemic stroke [2] and chronic kidney disease [3]. Therefore, sweetened beverage consumption is likely a risk factor for transient ischemic attack, a milder degree of stroke. Sweetened beverage consumption is warranted in this case and might potentially potentiate the adverse effect of energy drinks. Vareena Laohaphan, MD Department of Emergency Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand Narat Srivali, MD Department of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, MN, USA Corresponding author. Mayo Clinic, Rochester, MN, 55905, USA E-mail address: srivali.narat@mayo.edu http://dx.doi.org/10.1016/j.ajem.2014.11.052 References http://dx.doi.org/10.1016/j.ajem.2014.11.054 References [1] Pennay AE, Lubman DI. Energy drinks: health risks and toxicity. Med J Aust 2012;196 (7):442. [2] Dikici S, Saritas A, Besir FH, Tasci AH, Kandis H. Do energy drinks cause epileptic seizure and ischemic stroke? Am J Emerg Med 2013;31:274.e1–4. [3] Dikici S, Aydin LY, Kutlucan A, Ercan N. What do we know about energy drinks? Dicle Med J 2012;39(4):609–13. http://dx.doi.org/10.5798/diclemedj.0921.2012.04.0212. [4] Dikici S, Saritas A, Kilinc S, Guneysu S, Gunes H. Does an energy drink cause a transient ischemic attack? Am J Emerg Med 2014. http://dx.doi.org/10.1016/j.ajem. 2014.06.037 [pii: S0735-6757(14)00489-6, Epub ahead of print]. [5] Bernstein AM, de Koning L, Flint AJ, Rexrode KM, Willett WC. Soda consumption and the risk of stroke in men and women. Am J Clin Nutr 2012;95(5):1190–9. [1] Dikici S, Saritas A, Kilinc S, Guneysu S, Gunes H. Does an energy drink cause a transient ischemic attack? Am J Emerg Med 2015;33(1):129.e5–6. [2] Larsson SC, Akesson A, Wolk A. Sweetened beverage consumption is associated with increased risk of stroke in women and men. J Nutr 2014;144:856–60. [3] Cheungpasitporn W, Thongprayoon C, O'Corragain OA, Edmonds PJ, Kittanamongkolchai W, Erickson SB. Associations of sugar-sweetened and artificially sweetened soda with chronic kidney disease: a systematic review and meta-analysis. Nephrology (Carlton) 2014;19:791–7. ☆ Conflicts of interest: The authors disclose no conflicts. ☆☆ Authors' contributions: All authors were involved and approved the final manuscript.