Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

A Resuscitation Question So Obvious That . . . .


Here is a question that was asked as an example of something so obvious only an idiot would get it wrong.

I cannot come up with any right answer.

The immediate treatment of cardiac arrest includes all except:

A:       intubation

B:       Open cardiac massage

C:       IV (IntraVenous) access

D:       IV adrenaline

E:       USG (UltraSonoGraphy)

Who gets that wrong?


Open-chest cardiopulmonary resuscitation: past, present and future.

Define wrong.

Define immediate.

Are these supposed to be treatments that work?

In that case, we should define treatments that work.

Does work mean that the treatments are in some guidelines?

That is not the way I would interpret it.

Does work mean that the treatments improve survival to discharge (preferably much longer) with little, or no, neurological impairment.

If we ask patients, before they have a cardiac arrest, What do you want from treatment for cardiac arrest? – Isn’t that the way we would expect patients to define treatments that work?

Do we expect patient to answer with –

I want to spend a few days in a coma, have several more cardiac arrests, and never wake up. Don’t worry about the cost, because this kind of experience is priceless.

But that is the result of the treatments in the guidelines – except for continuous compressions and defibrillation.

So, if we look at the choices in the question –

Does intubation (any ventilation) improve outcomes in cardiac arrest?[1]

Does cracking the chest to squeeze the heart improve outcomes in cardiac arrest?[2]

Does IV access improve outcomes in cardiac arrest?[3]

Does IV adrenaline (epinephrine in non-Commonwealth countries) improve outcomes in cardiac arrest?[4]

Does USG improve outcomes in cardiac arrest?[5]

They are all supposed to work – except for one.

There are at least five problems with that question (not all of the choices are treatments).

None of these treatments can be shown to improve outcomes.


I mentioned the lack of efficacy of these treatments and received a bunch of links about intubation vs. supraglottic airways. I appreciate when people provide evidence to support their position. It makes a discussion much more reasonable.

The problem is that I was not looking to make a choice between endotracheal intubation and supraglottic airway. I am looking for evidence that any kind of ventilation improves outcomes that matter. The same is true for open chest massage, IV access, IV adrenaline, and USG.

Why send me irrelevant research? 😳

Will I be so impressed with some research, that I do not realize that the papers are irrelevant to the question being discussed?

The thread of questions and the responses promptly went down a memory hole.[6]

Why do we care so little about our patients that we use treatments that are harmful?

Why do we care so little about our patients that we use treatments where we haven’t even bother to find out how much harm they do?


[1] Prove it – Ventilation improves survival from cardiac arrest
Tue, 11 Sep 2012
Rogue Medic

[2] Open-chest cardiopulmonary resuscitation: past, present and future.
Alzaga-Fernandez AG, Varon J.
Resuscitation. 2005 Feb;64(2):149-56. Review.
PMID: 15680522 [PubMed – indexed for MEDLINE]

The object effective CPR is to restore the spontaneous systemic circulation as soon as possible to avoid any neurological damage and to obtain higher survival and outcome rates. Experimentally, OCCPR increases the time window for successful resuscitation and has demonstrated to be superior in maintaining hemodynamic variables almost in the normal physiological range. Hence, OCCPR should be integrated with CCCPR into a logical resuscitation protocol which will assure better survival opportunities.


It should be studied, but the evidence is most from studies of dogs.

[3] I do not know of any research addressing this. It would be foolish to assume that outcomes are improved without evidence.

[4] Killing Patients Just to Get a Temporary Pulse With Epinephrine
Wed, 21 Mar 2012
Rogue Medic

[5] I do not know of any research addressing this. It would be foolish to assume that outcomes are improved without evidence.

[6] Memory hole



  1. The handle on the rib-spreader should be on the lateral side, so you can go clamshell.

    Hey, it might help… Or might not.