Furosemide is good for filling the patient’s bladder, but the patient probably did not call for help filling his/her bladder.

- Rogue Medic

Bad Shock – Automated Devices for Jolting Hearts May Save Fewer Lives in Hospitals


Image credit.

Do AEDs (Automated External Defibrillators) save lives?

Yes, but . . .

Just over a decade ago, hospitals around the country began spending millions of dollars to buy automated defibrillators to save the lives of more patients who go into sudden cardiac arrest. The purchases were spurred by a recommendation from an American Heart Association committee that decided the new equipment would bring patients speedier emergency help.[1]

and

A FairWarning review of the decision that prompted the switch reveals that the pivotal committee recommendation was made without clinical research answering a crucial question: Did the new devices, when used in hospitals, produce better results than the old equipment?

Instead, committee members endorsed automated defibrillators largely on the unproven theory that they would improve response times because even less-skilled hospital staffers could operate them.[1]

This is the beginning of an article that makes some valid points, but ends up concluding that this apparent mistake was due to financial bias.

I think that this conclusion by the author is based on an ideological bias of the author.

Did the AHA (American Heart Association) make inappropriate recommendations without any research?


Image credit.[2]

Class IIa?

Class IIa
Benefit >> Risk
It is reasonable to perform procedure/administer treatment or perform diagnostic test/ assessment.[3]

What about research to support this claim?

Extraordinary survival rates—as high as 49%—have been reported in PAD programs.17 18 19 20 21 22 23 24 These rates are twice those previously reported for the most effective EMS systems.25 [4]

But that is not in hospitals.

AEDs are also used by healthcare professionals in ambulances, hospitals, dental clinics, and physicians’ offices.29 30 31 32 33 34 [4]

While most of those are discussions of the concept of in hospital AED use, there is also research.

Should there have been more research?

That is an important question. I think that the AHA (and ILCOR – International Liaison Committee on Resuscitation) are too quick to implement new treatments. A big problem is that the treatments become Standards Of Care and are difficult to remove from guidelines once enshrined there.

I have stated before that these recommendations need to come with an expiration date, after which they are removed from the guidelines, unless there is strong evidence to support their efficacy.

Does that mean that I think those encouraging the rapid implementation of unproven, or not well studied treatments, are corrupt?

No.

Those who are prone to conspiracy theories seem to see corruption everywhere in everyone else. And it is often just about money. People seem to be much more willing to break laws for ideology, than for money. Money is the simple answer for those who do not want to have to understand.

Maybe I am reading too much into this. Maybe FairWarning really is fair or objective.

Earlier this year, FairWarning did a report claiming that a report by a bunch of lawyers raises important questions about vaccines and autism.[5]

No, I am not reading too much into their actions. FairWarning makes a home for at least one full blown conspiracy theorists. Here is a little bit about the lawyers behind this research.

They are Mary Holland, a lawyer who wrote the chapter defending Andrew Wakefield in the recent book Vaccine Epidemic; Louis Conte, the father of two boys he believes are vaccine injured and the former director of something called the “Vaccine Injury Compensation Program Justice Project”; Robert Krakow, who is an attorney who represents clients who have filed Vaccine Court claims and who has filed his own claim on behalf of his son; and Lisa Colin, one of Krakow’s colleagues.[6]

The lawyer-study is reviewed by a real scientist at Science-Based Medicine.[7] When will the scientifically naive stop falling for the fraud of a vaccine/autism connection?


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Antivaccinationists and research are a ridiculous combination. Did Lilly Fowler write about vaccines and autism? No, but she did write about cell phones and cancer as if she thinks she understands the research. Giving press to a bunch of lawyers pushing a profitable conspiracy theory demonstrates that FairWarning‘s editors do not have any integrity. Nor do they have any understanding of medical research, so how much confidence should we have in their reporters?

The only fair warning about this organization is to avoid their reliance on stereotypes. Stereotypes are just the breeding ground for conspiracy theories.

They also have their donate button all over the place so that the more susceptible to snake oil can be separated from their money more easily.

I will write about what the the actual study, Automated external defibrillators and survival after in-hospital cardiac arrest,[8] found next week. Thank you to Greg Friese of Everyday EMS Tips, EMS EduCast, and Medical Author Chat for sending me the article.

Footnotes:

[1] Bad Shock: Automated Devices for Jolting Hearts May Save Fewer Lives in Hospitals
By Lilly Fowler
November 14, 2011
Fair Warning
Article

[2] Part 4: The Automated External Defibrillator : Key Link in the Chain of Survival
2000 AHA Guidelines
Circulation. 2000;102:I-60-I-76, doi:10.1161/01.CIR.102.suppl_1.I-60
Free Full Text from Circulation with links to Free PDF Download

[3] Ethics, Research, and IRBs
Rogue Medic
Part II
Part II

[4] Part 4: The Automated External Defibrillator : Key Link in the Chain of Survival
2000 AHA Guidelines
Circulation. 2000;102:I-60-I-76, doi:10.1161/01.CIR.102.suppl_1.I-60
Free Full Text from Circulation with links to Free PDF Download

[5] Analysis Finds Evidence of Autism in Many Vaccine Injury Cases
By Laurie Udesky
May 10, 2011
FairWarning
Report

[6] And the winner is…Fox News
By Seth Mnookin
Posted: May 10, 2011
The Panic Virus
Article

[7] When you can’t win on science, invoke the law…
Science-Based Medicine
Article

[8] Automated external defibrillators and survival after in-hospital cardiac arrest.
Chan PS, Krumholz HM, Spertus JA, Jones PG, Cram P, Berg RA, Peberdy MA, Nadkarni V, Mancini ME, Nallamothu BK; American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) Investigators.
JAMA. 2010 Nov 17;304(19):2129-36. Epub 2010 Nov 15.
PMID: 21078809 [PubMed – indexed for MEDLINE]

Free Full Text from JAMA with links to Full Text PDF Download

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Comments

  1. What’s the level of evidence for AEDs in hospitals? I love it when Class I and Class II level interventions comes with a level of evidence of C (This really really really works… BECAUSE I SAID SO, THAT’S WHY).

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