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

- Rogue Medic

Why is progress so slow in resuscitation research?


Why is progress so slow in resuscitation research? A lot of money and time went in to finding out which type of blood-letting ventilation works best – ignoring the absence of valid evidence that ventilation is better than no ventilation. Why not gamble with our patients?

In response to The Fatal Flaw in Trial of Continuous or Interrupted Chest Compressions during CPR,[1],[2] Kenny commented that –

there are many things in your blog that are not correct.[1]


I asked for specifics and received the following from Anonymous (maybe Kenny and maybe not) –

That the study design ASSUMES we don’t want to know if ventilation is useful or not.[1]


Ventilation study implied facepalm

Assumes is not many things, but the comments may be from different people and there may be so many things, that Kenny is still documenting all of the examples. Perhaps the following is more specific wording that will satisfy defenders of the study –

    The study design strongly suggests that

        in the attempted resuscitation of adult patients

            with cardiac causes of cardiac arrest

                which is almost all cardiac arrest patients

                    active ventilation does not need evidence,

                        but selecting the favorite flavor of ventilation

                            does need expensive high quality evidence

                                just in case someone ever produces valid evidence

                                    that these patients are not harmed by ventilations

                                        and that these patients receive some benefit from ventilations.

That is a lot to assume believe without appropriate evidence.

Based on the available evidence, what are the odds that ventilations are not harmful and are beneficial?

Does anyone have any good argument to give ventilations as much as a 50% chance?

What about a 40% chance that ventilations will survive a valid study?

How about a 30% chance?


Is there any justifiable reason to be so optimistic?

If there isn’t any justifiable reason to be optimistic, then we are only making assumptions when we take shortcuts to eliminate the essential research in order to study something that is traditional, rather than based on valid evidence.

Do the authors understand that there isn’t valid evidence of any benefit/lack of harm from active ventilations?

Do the authors care that there is not valid evidence of any benefit/lack of harm from active ventilations?

If I have overlooked a third possibility, somebody should let me know. If there is valid evidence, somebody should provide it.


[1] The Fatal Flaw in Trial of Continuous or Interrupted Chest Compressions during CPR
Wed, 25 Nov 2015 10:15:20
by Rogue Medic

[2] Trial of Continuous or Interrupted Chest Compressions during CPR.
Nichol G, Leroux B, Wang H, Callaway CW, Sopko G, Weisfeldt M, Stiell I, Morrison LJ, Aufderheide TP, Cheskes S, Christenson J, Kudenchuk P, Vaillancourt C, Rea TD, Idris AH, Colella R, Isaacs M, Straight R, Stephens S, Richardson J, Condle J, Schmicker RH, Egan D, May S, Ornato JP; ROC Investigators.
N Engl J Med. 2015 Nov 9. [Epub ahead of print]
PMID: 26550795

Free Full Text from NEJM.

Nichol, G., Leroux, B., Wang, H., Callaway, C., Sopko, G., Weisfeldt, M., Stiell, I., Morrison, L., Aufderheide, T., Cheskes, S., Christenson, J., Kudenchuk, P., Vaillancourt, C., Rea, T., Idris, A., Colella, R., Isaacs, M., Straight, R., Stephens, S., Richardson, J., Condle, J., Schmicker, R., Egan, D., May, S., & Ornato, J. (2015). Trial of Continuous or Interrupted Chest Compressions during CPR New England Journal of Medicine DOI: 10.1056/NEJMoa1509139



  1. Bang! [drops mic, walks off stage]

  2. As I noted when this came up on Facebook a couple of weeks ago, there is, in fact, evidence that chest compressions alone are not sufficient to oxygenate patients in cardiac arrest, and other research from the same time frame which showed that PPV did restore and maintain oxygenation, which is why PPV was incorporated into CPR at its inception.

    The problem is that the evidence is from 1961. Even if our standards for “sufficient evidence” had not changed since then, our understanding of cardiac arrest, and our other interventions (including how we perform the chest compressions at the heart of the original research), have changed so much in the last 55 years that the original data is no longer applicable, and it has not been revisited even tangentially until relatively recently.

    More recent research is suggesting that PPV is no longer needed, and may have other effects which reduce survival. But that hypothesis has not yet been sufficiently studied.

    An immediate trial is certainly needed – anything else would be gross negligence – but there will be a delay. I expect there will be issues with IRB approval and political interference that will make the epi vs. placebo trials look like a cakewalk. In the meantime, I do not see an issue in continuing the accepted evidence based intervention, which is quality chest compressions with PPV.

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