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

- Rogue Medic

Emergency Cardiovascular Care Update (ECCU) 2014 Conference – What Will We Get?

 

What should we expect from the Emergency Cardiovascular Care Update (ECCU) 2014 Conference?

The brochure suggests that the next version of the guidelines will be based more on science than the current guidelines, but that is always the suggestion.
 


 

Will the AHA (American Heart Association) actually limit treatments to those that work?

Or will we get more wishful thinking-based guidelines?

There is an examination of the research that will affect the next decade of BLS (Basic Life Support) resuscitation.
 


 

There is also a session where questions are encouraged.
 


 

Will we continue to harm patients with ventilations?

There is still no evidence of benefit from ventilations prior to ROSC (Return Of Spontaneous Circulation). We would still ventilate those who arrested secondary to respiratory causes and children.
 

That format is repeated for ALS (Advanced Life Support).
 


 

And a session where questions are encouraged.
 


 

Will we still be giving eye of newt?

While eye of newt has not been shown to increase the rate of ROSC, it has not been studied, so we do not know if eye of newt does increase the rate of ROSC.

Epinephrine (Adrenaline in Commonwealth countries) is slightly more evidence-based than eye of newt, because it has been shown to increase the rate of ROSC, but who cares?

ROSC is not the goal.

Resuscitation of the heart and brain is the goal.

Epinephrine has failed to demonstrate improved resuscitation.
 

What works?

Teaching CPR effectively works.

Ventilations impair outcomes and impair education.
 


 

What can we do to improve the quality of CPR?
 


 

What can we do to improve the quality of EMS?

EMS resuscitation is not an ALS treatment.

EMS resuscitation is about keeping the medics out of the way of the people providing compressions and defibrillations.
 


 

Resuscitation does not come in a syringe, so prehospital therapeutic hypothermia is not going to be done with chilled IV fluids.

We know that does not work.
 


 

Stutter CPR looks promising, but we are not there, yet.
 


 

What do we do after ROSC?

Higher pressures seem to lead to higher resuscitation rates, but is that just an association of healthier hearts producing higher blood pressures, is it something we can improve with pressors (epinephrine, norepinephrine, phenylephrine – but probably not with dopamine), or is it something that we will make worse with pressors?
 


 

There is even a discussion of mechanical Compression devices.

Should we teach excellent chest compressions to bystanders, while we abandon quality EMS compressions to machines?

If quality is a problem, we should give the machines to bystanders and demand high quality from EMS.

Or is it possible that the machines can act as prehospital ECMO and improve outcomes? We do not know – yet.
 


 

It looks interesting.

I hope the results are a dramatic improvement over the current (2010) guidelines.

The 2005 guidelines made a big difference in compression quality and the resuscitation rates followed.

2015 could cause us to focus on what really works.

If it doesn’t work when we study it, then we were just fooling ourselves about whether it works. If it doesn’t work when we study it, it does not work.
 

Emergency Cardiovascular Care Update (ECCU) 2014 Conference

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Comments

  1. I’m glad you are open to the idea it won’t change anything of substance. I say follow the money….

    • Toasted Medic,

      While the AHA has had problems with the appearance of recommending treatments based on money from Wyeth for amiodarone (Cordarone manufactured only by Wyeth at that time) and money from Genentech for tPA (Activase brand of alteplase only manufactured by Genentech).

      Activase has an unusually long patent. It was first approved in the US in 1987, which should have had it off patent almost a decade ago. I have seen the patent expiration listed as 2005, but more recent pages show the patent expiration as 2015. Will the patent be extended, again?

      Amiodarone and tPA are still recommended by the AHA, but there is not good evidence to recommend them.

      I think that the biggest problem is not financial, but the unreasonable optimism that encourages people to do something, anything, rather than avoid harming the patient. Harming the patient is not good, but it is often the standard of care. If we do not have good evidence of benefit, we should assume that the treatment is harmful.

      There are no drugs that have good evidence of benefit, but the AHA (ILCOR, too) recommends a lot of drugs for cardiac arrest. Bizarrely, they discourage giving more than 3 NTG tans to any one patient, even though high-dose NTG for CHF is one drug treatment with good evidence of benefit.

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