We are there for the good of the patient, not for the good of the protocol, not for the good of the medical director, and not for the good of the company.

- Rogue Medic

What Helps Patients in Resuscitation and What Helps Only Us

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What do we do in cardiac arrest that improves outcomes? This is only looking at adult cardiac arrest of cardiac origin, because that is almost every cardiac arrest that we treat.

We frequently seem to make the mistake of basing our treatment of 90% of our patients on what might work for less than 10% of our patients. I am ignoring those zebras.

What works?

Chest compressions -

Cardiocerebral resuscitation improves survival of patients with out-of-hospital cardiac arrest.
Kellum MJ, Kennedy KW, Ewy GA.
Am J Med. 2006 Apr;119(4):335-40.
PMID: 16564776 [PubMed - indexed for MEDLINE]

Cardiocerebral resuscitation improves neurologically intact survival of patients with out-of-hospital cardiac arrest.
Kellum MJ, Kennedy KW, Barney R, Keilhauer FA, Bellino M, Zuercher M, Ewy GA.
Ann Emerg Med. 2008 Sep;52(3):244-52. Epub 2008 Mar 28.
PMID: 18374452 [PubMed - indexed for MEDLINE]

Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest.
Bobrow BJ, Clark LL, Ewy GA, Chikani V, Sanders AB, Berg RA, Richman PB, Kern KB.
JAMA. 2008 Mar 12;299(10):1158-65.
PMID: 18334691 [PubMed - indexed for MEDLINE]

Free Full Text at JAMA

Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest.
Bobrow BJ, Ewy GA, Clark L, Chikani V, Berg RA, Sanders AB, Vadeboncoeur TF, Hilwig RW, Kern KB.
Ann Emerg Med. 2009 Nov;54(5):656-662.e1. Epub 2009 Aug 6.
PMID: 19660833 [PubMed - indexed for MEDLINE]

And more.

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Defibrillation -

Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.
Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG.
N Engl J Med. 2000 Oct 26;343(17):1206-9.
PMID: 11071670 [PubMed - indexed for MEDLINE]

Free Full Text from NEJM with link to PDF Download

Rapid on-site defibrillation versus community program.
Fedoruk JC, Paterson D, Hlynka M, Fung KY, Gobet M, Currie W.
Prehosp Disaster Med. 2002 Apr-Jun;17(2):102-6.
PMID: 12500734 [PubMed - indexed for MEDLINE]

Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest.
Mosesso VN Jr, Davis EA, Auble TE, Paris PM, Yealy DM.
Ann Emerg Med. 1998 Aug;32(2):200-7.
PMID: 9701303 [PubMed - indexed for MEDLINE]

And more.

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Ventilation -

 

No evidence of benefit for adult cardiac arrest of cardiac origin.

 

Airways -

 

No evidence of benefit for adult cardiac arrest of cardiac origin.

 

Interrupting compressions to charge the defibrillator -

 

No evidence of any benefit – ever.

 


Image credit.

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Epinephrine -

 

No evidence of benefit in cardiac arrest.

 

Amiodarone -

 

No evidence of benefit in cardiac arrest.

 

Atropine -

 

No evidence of benefit in cardiac arrest.

 

Bleeding -

 

No evidence of benefit in cardiac arrest.

 

Homeopathy -

 

No evidence of any benefit – ever.

 

Acupuncture -

 

No evidence of any benefit – ever.

 

Anything that is not compression or defibrillation -

 

No evidence of benefit in cardiac arrest.

 

Is there any important difference between epinephrine and homeopathy in cardiac arrest? Between amiodarone and acupuncture in cardiac arrest? Between ventilation and atropine in cardiac arrest?

No.

We just pretend that things that make us feel important provide some benefit to the patient.

If there is no evidence of benefit to the patients (improved survival with good brain function), the only benefit is to us.

This is not ethical behavior.

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