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

- Rogue Medic

2020 ACLS Repeats the Mistakes of 2015 ACLS

Wed, 21 Oct 2020 12:10:23 -0400 by

 

 

The International Liaison Committee on Resuscitation (ILCOR) has updated the ACLS (Advanced Cardiac Life Support) recommendations by making excuses for the evidence.

 

We have been using epinephrine for 50 years without evidence of improved outcomes that matter to patients.

 

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest (Paramedic2) shows that epinephrine does not improve outcomes for prehospital patients.

 

In conclusion, in this randomized trial involving patients with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of survival at 30 days than the use of placebo, but there was no significant between-group difference in the rate of a favorable neurologic outcome because more survivors had severe neurologic impairment in the epinephrine group.

 

Rather than limit treatments to those with high quality evidence that they improve outcomes that matter to patients, the recommendation is to keep giving epinephrine, because eventually someone might provide something – anything – to support epinephrine.

 

What about amiodarone?

 

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest (ALPS) showed that amiodarone also does not improve outcomes.

 

Conclusions Overall, neither amiodarone nor lidocaine resulted in a significantly higher rate of survival or favorable neurologic outcome than the rate with placebo among patients with out-of-hospital cardiac arrest due to initial shock-refractory ventricular fibrillation or pulseless ventricular tachycardia.

 

If amiodarone was mentioned, I missed it. Both epinephrine and amiodarone had large placebo-controlled research results released showing that the outcomes are worse with epinephrine and worse with amiodarone.

 

There is still no evidence that any ventilation produces better outcomes than compression-only resuscitation, but it looks like the intervention will continue to be recommended.

 

In the absence of evidence of benefit, inadequately tested interventions should be avoided.

 

The goal is to protect the patients, not to protect the interventions.

 

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Filed Under: ACLS, Defibrillation, Epinephrine, Ethics, Evidence, Heresy, Intubation, Naloxone, PALS, Pharmacology, Potentially Reversible Causes, Research, Superstition, Ventilation

Happy Friday the 13th

Fri, 13 Dec 2019 23:55:25 -0500 by

One of the Most Holy Days of the Church of Anecdote and Confirmation bias is here.

Will it be quiet? Oops, the utterance of the word Quiet can turns any day into a Friday the 13th for some celebrants of this religion, at least for those who work in EM/EMS (Emergency Medicine/Emergency Medical Services).

Are these superstitions unreasonable? Absolutely, but try explaining that to someone who rejects reason.

How do you reason with people who reject reason? Presenting large quantities of objective evidence is not going to matter to believers, because their self-worth depends, to some extent, on protecting themselves from being reasonable.

A coincidence is a remarkable concurrence of events or circumstances that have no apparent causal connection with one another. The perception of remarkable coincidences may lead to supernatural, occult, or paranormal claims. Or it may lead to belief in fatalism, which is a doctrine that events will happen in the exact manner of a predetermined plan.

From a statistical perspective, coincidences are inevitable and often less remarkable than they may appear intuitively. An example is the birthday problem, which shows that the probability of two persons having the same birthday already exceeds 50% in a group of only 23 persons.[1] [1]

Uncountable numbers of unrelated events happen at apparently the same time. Since time itself is relative, the point of reference of the observer can be a factor in the appearance of coincidence. For example, thunder will be heard by a person at the same time the person sees lightning, while a mile away, a person sees the lightning 5 seconds before hearing the thunder. The thunder and lightning have the same cause, but the lightning and the thunder separate by even more time, from the perspective of even more distant observers.

The lack of perspective about observations has led people to develop more superstitions about coincidences than have been documented.

Casinos depend on superstition.

You have a system? Excellent. Come and apply your system to our games of chance. We will take your bets.

Casinos will not just take just your bets. Casinos will take trillions of dollars of bets, because they have arranged the odds to be, at least, slightly in their favor.

Do you wait for someone to put all of their money into a slot machine, then take their seat, expecting that the machine is overdue to pay out?

Casinos pay millions of dollars for famous people to perform on stage to draw you in to use that kind of system. The Casino will take your bet. Your money will help to pay even more for expensive entertainers.

You count cards?

Brilliant! The dealer, or a manager, is also counting cards and trained to recognize when someone is using a betting system based on card counting. The cameras, which watch everything happening at the tables, are also helping to track your habits. The cameras will also get high quality images of you, which casinos share as part of their countermeasures. Card counting is not illegal, but the casino can do a lot to keep the odds in the favor of the casino.

Roulette games have systems, as well. Likewise, the casinos want you to bet your money on your systems. They have bills to pay and your money is just a drop in the bucket to the casinos.

You don’t believe in coincidences?

Companies make trillions of dollars off of your belief. Your belief is their business and their business is profitable.

However, if you want to get better at recognizing the biases you have, challenge yourself to bets on the outcomes of your beliefs. It doesn’t have to be money. You can bet doing something you don’t want to do against doing something you do want to do, based on whether you are right about something you believe.

Write down what you believe/believe will happen. Write down your criteria for winning/losing. Don’t make excuses for fudging the criteria. Maybe doing something that you should do, but really don’t want to do. Think of how much you will accomplish – if you are honest with yourself and you set your bets up objectively.

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Footnotes:

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[1] Coincidence
Wikipedia
Web page

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Filed Under: Evidence, Heresy, Mythology, Probability, Superstition

Happy Full Moon Friday the 13th

Fri, 13 Sep 2019 23:00:33 -0400 by

Technically, the full moon is not until 00:33 – 33 minutes after the end of Friday the 13th, so that may help the superstitious to feel better, since these superstition events are not actually coinciding – pitting twice as many Gods against the superstitious (a double whammy). Or the superstitious may feel worse, because they now have two days in a row of the Gods conspiring against them. The reality is that only their own beliefs conspire against them. it is all in the heads of the believers.

Even when someone does claim to come up with some evidence to support their beliefs, those conclusions are not supported by higher quality research.
 

In conclusion, Friday the 13th appears to be dangerous for some women. Since Friday falls on the 13th day of the month only twice a year on average, prospects for significant public health gains are limited. However, the risk of death for women who venture into traffic on this unlucky day is higher by 63%, and it should be possible to prevent one-third of the deaths occurring on this particular day. Even then, the absolute gain would remain marginal, since only one death per 5 million person-days could be prevented.[1]

 

The total number of deaths is small. Drawing that conclusion, based on a small sample size is a problem. In order to be able to come up with larger numbers, to minimize the effects of the small sample size, other researchers looked at the motor vehicle collisions, rather than just fatal motor vehicle collisions. The assumption that the cause of the fatalities was anxiety, produced by superstition among the drivers is projecting a lot onto the drivers – without any evidence to support this supposed cause.

It should not be a surprise that the results of a much larger sample size contradicts the assumptions based on the much smaller sample.
 

Conclusion:
We conclude that, in the Finnish traffic accident statistics for 1989–2002, females have not incurred more injury (or fatal) road traffic accidents on Fridays the 13th than expected, as a driver, bicyclist or pedestrian. We suggest that Näyhä’s contradicting result on fatalities is due to different sampling, non-optimal setting and chance in a fairly small data. However, this does not imply a nonexistent effect on accident risk as no exposure-to-risk data [18] are available. People who are anxious of “Black Friday” may stay home, or at least avoid driving a car. The only relevant data [4], suggesting a small decrease in highway traffic, is rather limited and should be confirmed with more extensive research.[2]

 

The law of small numbers is an attempt to expose the mistake of extrapolating from small numbers as if the small numbers are representative. Small numbers are misleading. Small numbers are often used to promote ideas that are not supported by adequate numbers – such as the claims that epinephrine improves cardiac arrest outcomes that matter, or that amiodarone improves cardiac arrest outcomes that matter.[3]

Footnotes:

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[1] Traffic deaths and superstition on Friday the 13th.
Näyhä S.
Am J Psychiatry. 2002 Dec;159(12):2110-1.
PMID: 12450968

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[2] Females do not have more injury road accidents on Friday the 13th.
Radun I, Summala H.
BMC Public Health. 2004 Nov 16;4:54.
PMID: 15546493

Free Full Text from PubMed Central.

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[3] Chapter 10
The Law of Small Numbers
Thinking, Fast and Slow
Daniel Kahneman
2011
Wikipedia page

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Filed Under: Critical Judgment, Evidence, Full Moon, Heresy, Mythology, Research, Superstition

Happy Friday the 13th – Only Ten Days to the Next End of the World

Fri, 13 Apr 2018 17:53:53 -0400 by
 
I hope that you have been out enjoying the day as much as I have. You have two extra days to procrastinate, before taxes are due this year on the 17th.

The End of the World isn’t coming until after taxes are due, so don’t let that discourage you.

What will we do when the brimstone hits the fan, this time?[1]
 


 

The same thing we did last time, and the time before that, and the time before that, and . . . .

We will listen to more excuses.

There have been many Ends of the World, but nobody seems to have noticed.

We need to demand better Ends of the World.

Why do prophets get away with such low standards?

We should notice something.

Maybe I should sell End of the World protection amulets.
 

This survived the last End of the world, and the one before that, and the one before that, and . . .

Clearly, this is extremely effective and reusable.

Act now.

Your supply of gullibility may be limited.

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Footnotes:

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[1] End of the world 2018: Will the Rapture occur on April 23? SHOCK prediction says YES
THE end of the world could be arriving sooner than we thought, as a new theory suggests we are now in the ‘end times’. Could this shock prophecy be true? Will the Rapture occur on April 23?
By Owen Gough
Published: 07:09, Fri, Apr 13, 2018 | Updated: 11:36, Fri, Apr 13, 2018
Article

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Filed Under: Heresy, Mythology, Superstition

Have a Slow, Quiet Friday the Thirteenth

Fri, 13 Oct 2017 17:05:09 -0400 by
Also to be posted on ResearchBlogging.org when they relaunch the site.
 

 

Superstitious appears to be common among medical people, so this may be seen as offensive. If you doubt me, comment that it is slow or quiet and see how many respond negatively, while they do not receive any criticism for their superstition-based complaints. Rather, people will make excuses for coddling the superstitions of those who are entrusted with the lives of patients.

The evidence does not support their superstitions.

One study did appear to show that women die in motor vehicle collisions more often on Friday the 13th, but that appears to be due to a lack of understanding of statistics by many who cite the article.
 

An additional factor is anxiolytic medication, used by significantly more women than men in Finland (7), which has been reported to reduce attention span and worsen driving performance (8). . . . Why this phenomenon exists in women but not in men remains unknown, but perhaps the twice-as-high prevalence of neurotic disorders and anxiety symptoms in women (7) makes them more susceptible to superstition and worsening of driving performance.[1]

 

The author suspects that those people with conditions that could be diagnosed as neuroses or anxiety disorders may be disproportionately affected by superstition.

In other words, superstition is not an external force affecting you. You are doing it to yourself.

The sample size was national, but still small, and was not able to adjust for many possible confounding variables, so the study would need to be replicated using a much larger data base to be useful.

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In other superstition news – the next apocalypse, in a long line of predicted apocalypses, is going to be this Sunday – the 15 of October, 2017, according to David Meade. Meade twice previously predicted that a magical planet would hit the Earth and kill us all. This time he claims that his calculations are accurate, because that was the problem with his previous calculations – inaccuracy, not that they were a superstition deserving of derision.

If you are superstitious, and feel that your neuroses/anxieties will cause you to harm others, or yourself, you may want to stay home today and Sunday – perhaps even until you are capable of grasping reality.

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Of course, we would never base treatment on superstition in medicine.

Amiodarone is the go to antiarrhythmic drug for cardiac arrest and ventricular tachycardia, but there are much safer much more effective drugs available. We have our own prophets misrepresenting research results to make it seem that using amiodarone for these is a good idea. The research says these preachers are wrong. The next guidelines will probably promote the superstition and reject the science.[2],[3]

Ventilation during cardiac arrest has been shown to be a good idea only for patients who arrested for respiratory reasons. We do a great job of identifying these patients. We have our own prophets misrepresenting research results to make it seem that providing ventilations for these is a good idea. The research says these preachers are wrong. The next guidelines will probably promote the superstition and reject the science.[4]

Medicine is full of superstition and superstitious people.

Why?

Too many of us believe the lie that, I’ve seen it work.

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I have also written about the superstition of Friday the 13th here –

Acute coronary syndrome on Friday the 13th: a case for re-organising services? – Fri, 13 Jan 2017

The Magical Nonsense of Friday the 13th – Fri, 13 May 2016

Happy Friday the 13th – New and Improved with Space Debris – Fri, 13 Nov 2015

Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition? – Fri, 13 Jun 2014

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008

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Footnotes:

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[1] Traffic deaths and superstition on Friday the 13th.
Näyhä S.
Am J Psychiatry. 2002 Dec;159(12):2110-1.
PMID: 12450968

Free Full Text from Am J Psychiatry.

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[2] The PROCAMIO Trial – IV Procainamide vs IV Amiodarone for the Acute Treatment of Stable Wide Complex Tachycardia
Wed, 17 Aug 2016
Rogue Medic
Article

There are a dozen links to the research in the footnotes to that article. There are also links to other articles on the failure of amiodarone to live up to its hype.

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[3] Dr. Kudenchuk is Misrepresenting ALPS as ‘Significant’
Tue, 12 Apr 2016
Rogue Medic
Article

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[4] Cardiac Arrest Management is an EMT-Basic Skill – The Hands Only Evidence
Fri, 09 Dec 2011
Rogue Medic
Article

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Filed Under: 'Alternative' Medicine, Airway Management, Anti-Science, Common Sense, Conspiracy Theories, Conventional Ignorance, Critical Judgment, EBM, Evidence, Full Moon, Miracles, Mythology, Narrative Fallacy, Research Blogging, Science, Superstition

Acute coronary syndrome on Friday the 13th: a case for re-organising services?

Fri, 13 Jan 2017 02:40:45 -0500 by
ResearchBlogging.orgAcute coronary syndrome on Friday the 13th - a case for re-organising services 1
 
There has been a bunch of research on the likelihood of bad things happening on Friday the 13th. These researchers thought that the big problem with all of the available research is that the populations studied have been too small. The authors took information on over 56,000 patients with acute coronary syndromes, broke them down into 217 day/date combinations (Friday the 1st, Saturday the 1st, . . . ,Wednesday the 31st, Thursday the 31st), and compared the outcomes of those 216 groups with their Friday the 13th group.

Cut to the conclusion –
 

Conclusion: On most days, there was no difference in the 13-year mortality rate for patients admitted with their first ACS from that for “unlucky” Friday the 13th. However, patients admitted on five day/number combinations were 20-30% more likely to survive at 13 years. These findings could be explained by subgroup analysis inflation of the type I error, although supernatural causes merit further investigation.[1]

 

No. Supernatural causes do not merit further investigation, at least, not based on anything in this paper.

The authors used Friday the 13th as their normal date for comparison with every other date, but the outcomes from Friday the 13th are not the true statistical mean. The outcomes on Friday the 13th were just chosen because of the superstition being investigated. Friday the 13th is so close to the statistical mean that this mistake is easy to make.
 

Surprisingly, however, we also identified five potentially “lucky” days on which mortality rates were significantly lower, by 20-30%.[1]

 

When analyzing 217 samples, it is not surprising that some of the data deviate from average by an amount that is expected to produce no more than one significant deviation out of every twenty comparisons. The authors had over 200 comparisons, so we should not have been surprised by up to 11 day/date combinations with p values of less than 0.05. There were only 5. Should anyone go looking for supernatural explanations for statistically normal outcomes?

While Friday the 13th was not the statistical mean, it was very close. Look at the five potentially “lucky” days and how close the ranges are to 1.00. If the range crosses (includes) 1.00, the results are not statistically significant according to the prospectively determined criteria of the authors. Crossing 1.00 is just another way of expressing P <0.05. Sunday the 1st and Monday the 29th each produced outcomes 29% worse than Friday the 13th. Saturday the 31st produced outcomes that were 36% worse. If we compared these with the actual statistical mean, Monday the 29th and Saturday the 31st become significantly “unlucky” using a p value of less than 0.05 and all of the significantly “lucky” days become insignificant.

As we should expect, the most extreme benefit and harm both fall on the 31st. Only 7/12 (58.3%) of months have 31 days, so these days have much smaller sample sizes. With smaller samples, the appearance of deviance is expected to be greater. The actual deviation is less important, because the sample size is smaller.

Friday the 13th is only slightly different from the statistical mean, using the data in this paper, which may be the largest examination of a possible Friday the 13th effect.

Once again, the biggest problem with Friday the 13th is that we end up listening to people promoting superstition.
 

I have also written about this kind of superstition here –

The Magical Nonsense of Friday the 13th – Fri, 13 May 2016

Happy Friday the 13th – New and Improved with Space Debris – Fri, 13 Nov 2015

Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition? – Fri, 13 Jun 2014

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008

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Footnotes:

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[1] Acute coronary syndrome on Friday the 13th: a case for re-organising services?
Protty MB, Jaafar M, Hannoodee S, Freeman P.
Med J Aust. 2016 Dec 12;205(11):523-525.
PMID: 27927150

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Protty, M., Jaafar, M., Hannoodee, S., & Freeman, P. (2016). Acute coronary syndrome on Friday the 13th: a case for re-organising services? The Medical Journal of Australia, 205 (11), 523-525 DOI: 10.5694/mja16.00870

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Filed Under: Critical Judgment, Evidence, Heresy, Mythology, Research Blogging, Superstition

The Magical Nonsense of Friday the 13th

Fri, 13 May 2016 11:20:45 -0400 by
ResearchBlogging.org
 

Today we celebrate the fears of those who do not understand that magic does not affect reality. Our fears of magic can affect reality, when we act on those fears. Why should a special day cause more problems than a boring day? Many people believe in magic powers as being more than just the fictional entertainment we see in novels and movies.

Here is another study of the effects of Friday the 13th on emergency medicine/EMS that I have not written about. It is no surprise that they did not find what is not there – an influence of this magic date on the type or volume of patients in the emergency department.
 

CONCLUSIONS:
Although the fear of Friday the 13th may exist, there is no worry that an increase in volume occurs on Friday the 13th compared with the other days studies. Of 13 different conditions evaluated, only penetrating traumas were seen more often on Friday the 13th. For those providers who work in the ED, working on Friday the 13th should not be any different than any other day.[1]

 

When measuring of a large number of variables, it is expected that one, or more, will appear to be statistically significant. This is why the p value of outcomes should be adjusted when there are multiple outcomes being measured. The p value is just a measure of how likely it is that the result occurred by chance (and thus meaningless), so the more chances, the more likely that the meaningless is considered significant.
 

Fear of Friday the 13th is mistakenly attributing some magical power to a day, to a number, to the calendar, and/or to some other variation of belief in the magic of numbers.

Numbers are important and can provide us with useful information about the risks in our lives. The risks we take confidently, cautiously, or those we don’t take. Often our decisions about risk are based on faulty information, such as the fear of a date. Mathematical literacy is necessary to understand the ways that we can use numbers to obtain valid information. John Allen Paulos created the term innumeracy to describe our lack of literacy in the language of numbers. He explained this in 1988 in his book Innumeracy: Mathematical Illiteracy and its Consequences.[2]
 

Innumeracy cover
 


 

Oh! But what about Lies, damned lies, and statistics?

Doesn’t using math make it easier for people to lie to us?

No. Ignorance of math makes it easier for people to lie to us with math.

People do not often lie with numbers. People lie with words. Maybe they lie with the salesman smile. Maybe they lie with the fear monger frown. Maybe they lie unintentionally, because they don’t know what they are talking about. They lie with words. Our ignorance of logic, not our understanding of math, is what allows us to fall victim to most lies.

Today is another Friday that is no more exciting than any other Friday.

Luck works in our favor when we are prepared for the results of our actions, but that is not the kind of luck many people want to understand.
 

Happy Friday the 13th – New and Improved with Space Debris – Fri, 13 Nov 2015

Friday the 13th and full-moon – the ‘worst case scenario’ or only superstition? – Fri, 13 Jun 2014

Blue Moon 2012 – Except parts of Oceanea – Fri, 31 Aug 2012

2009’s Top Threat To Science In Medicine – Fri, 01 Jan 2010

T G I Friday the 13th – Fri, 13 Nov 2009

Happy Equinox! – Thu, 20 Mar 2008

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Footnotes:

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[1] Answering the myth: use of emergency services on Friday the 13th.
Lo BM, Visintainer CM, Best HA, Beydoun HA.
Am J Emerg Med. 2012 Jul;30(6):886-9. doi: 10.1016/j.ajem.2011.06.008. Epub 2011 Aug 19.
PMID: 21855260

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[2] Innumeracy: Mathematical Illiteracy and its Consequences
Wikipedia
Page on Wikipedia

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Filed Under: Heresy, Probability, Superstition

2015 In Review – Superstitious Standards of Care Suffer Small Losses, But Continue to be Favorites

Thu, 31 Dec 2015 14:40:08 -0500 by
 

What changed, or almost changed in 2015?

Withholding epinephrine (adrenaline in Commonwealth countries) in cardiac arrest is still heresy. This use of epinephrine is not based on evidence of improved outcomes that matter to patients – unless the patient is a pig/dog/rat with no heart disease having an artificially produced cardiac arrest.

The Jacobs trial ways sabotaged by politicians, the media, and other opponents of science claiming that depriving patients of the standard witchcraft is unethical.[1] Using inadequately tested hunches on uninformed patients, as long as everyone else is doing it, appears to be their idea of ethical behavior. However, the Paramedic2 trial has been underway for about a year and should provide results in 2018.[2]
 

paramedic2_logo
 

There probably is some benefit for cardiac arrest patients who are not having heart attacks, but we do not currently try to identify them. We also do not know what dose or frequency is best or when to give epinephrine. Paramedic2 will only be able to answer some of those questions.
 

Withholding ventilation is a less defended heresy, at least in Pennsylvania.
 

AVOID endotracheal intubation and patient packaging during initial 10 minutes

Ventilation Options6:

  • No Ventilation
  • 1 ventilation every 10-15 compressions8 (Monitor Perfusion with Capnography[3]

    •  

    However, the AHA (American Heart Association) and ILCOR (International Liaison Committee On Resuscitation) 2015 resuscitation guidelines double down on baseless fears –
     

    2015 Evidence Review
    There is concern that delivery of chest compressions without assisted ventilation for prolonged periods could be less effective than conventional CPR (compressions plus breaths) because the arterial oxygen content will decrease as CPR duration increases.    [4]

     

    There is no evidence to support this fear, but using reason against irrational beliefs is often unsuccessful, since the irrational appeals to emotion and avoids reason.
     

    Medical directors have been recognizing that backboards were used because of irrational fear and assumptions of benefit that were based on hunches. Therefore many medical directors now recognize the absurdity of the use of this malpractice device and discourage the use of backboards.
     

    Pennsylvania has also removed chilled IV fluid from protocols following the failure of the treatment to improve outcomes for cardiac arrest patients, when given by EMS.

    Chilled IV fluid therapeutic hypothermia does work in the hospital, but not when provided by EMS.

    This is one of the reasons EMS should not automatically adopt treatments that work in the hospital. It is difficult for many in EMS to understand, but many in EMS still think that occasionally intubating a patient makes a paramedic as good as an anesthesiologist.
     

    In general, the state of EMS is best summed up by this statement by Prachi Sanghavi –

    Our current ambulance system is based on little scientific evidence.

    The scary thing for patients is that many in EMS are proud of our ignorance.
     

    Elsewhere in medicine in 2015.

    Thousands of Americans travel to regions with outbreaks of Ebola and help to stop the spread of infection. This was in spite of the panic being encouraged by the scientifically illiterate. We should have welcomed them home as we welcome home out military. Both of these groups of Americans risk their lives to protect others and should be treated better. They are far more ethical than our isolationist politicians.

    We learned that we need to add rats to the growing list of the non-human animals that exhibit empathy and will sacrifice to help others.[5] It appears that comparing those who opposed sending Americans to rats is unfair to the rats.
     

    Finally, 2015 was the 100th anniversary of Albert Einstein explaining that Isaac Newton was wrong about gravity, but that is the way science improves.
     

    PS – We also had push dose pressors added to the Pennsylvania protocols in 2015.

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    Footnotes:

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    [1] Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial
    Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL.
    Resuscitation. 2011 Sep;82(9):1138-43. Epub 2011 Jul 2.
    PMID: 21745533 [PubMed – in process]

    Free Full Text PDF Download from semanticscholar.org
     

     

    This study was designed as a multicentre trial involving five ambulance services in Australia and New Zealand and was accordingly powered to detect clinically important treatment effects. Despite having obtained approvals for the study from Institutional Ethics Committees, Crown Law and Guardianship Boards, the concerns of being involved in a trial in which the unproven “standard of care” was being withheld prevented four of the five ambulance services from participating.

     

    In addition adverse press reports questioning the ethics of conducting this trial, which subsequently led to the involvement of politicians, further heightened these concerns. Despite the clearly demonstrated existence of clinical equipoise for adrenaline in cardiac arrest it remained impossible to change the decision not to participate.

     

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    [2] Paramedic2 – The Adrenaline Trial
    Warwick Medical School
    About

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    [3] General Cardiac Arrest – Adult
    3031A – ALS – Adult
    Pennsylvania Emergency Health Services Council
    PA ALS Protocols in PDF format

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    [4] 2015 Evidence Review
    2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
    Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality
    Adult BLS Sequence—Updated
    2015 Evidence Review

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    [5] Rats forsake chocolate to save a drowning companion
    Science Magazine
    By Emily Underwood
    12 May 2015
    Article

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    Edited 12-27-2018 to correct link to pdf of Jacobs study in footnote 1.

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    Filed Under: 2015 ACLS, Correction, Ethics, Evidence, Heresy, Superstition
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