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

- Rogue Medic

Mechanical CPR as an Excuse to Just Transport


 

Dr. Keith Wesley usually takes an approach that is focused on the patient.

Dr. Wesley is one of the doctors I use as an example of doctors who truly understand about the ways EMS can improve outcomes.

But . . .

Why is he suggesting that transporting during CPR is a good idea – except when it cannot be avoided?

Did the IAFF (International Association of Fire Fighters – EMS is about speed, not patient care) kidnap someone important to Dr. Wesley?
 

The researchers had a driver cover a predesignated course in the city with typical changes in direction, railway crossings and speeds up to 78 mph.[1]

 

Because it is about the speed of transport, not about the patient.

When the patient is dead, it is a good idea to slow down and transport safely, not try to make the rest of the occupants even more dead than the patient with the mechanical pulse.
 
 

 
Avoiding patient care, because we can drive fast!

How many of the Low Information Voters of EMS will look at this ridicule of IAFF policy and be proud that they value speed more than they value their patients’ lives?[2]

 
 

Keith Wesley’s Comments
Many may be asking why I reviewed a study with such obvious results.
[1]

 

Because the IAFF took your baby away?
 

Performing chest compressions is fatiguing and the back of an ambulance rolling lights and sirens through the night is downright dangerous. So dangerous, in fact, I consider it bordering on employer negligence if condoned or even sanctioned.[1]

 

This was a study comparing negligence with machine compressions to prove that it is less negligent to use a machine during transport.

We already know that we should be resuscitating patients on scene.

Does this study provide any kind of evidence of improved outcomes from this rush to transport as compared with treating real patients on scene?

No.

Does this even attempt to demonstrate benefit?

No.
 

When you combine the poor outcome of these cardiac arrest victims receiving worthless CPR while exposing the responders to career- or life-ending injuries, I simply wonder who is reading the science at all. If this information was well-known and accepted, then every ambulance in America would be equipped with a mechanical CPR device. So why aren’t they?[1]

 

Why are apples not oranges?

Why are we putting apples on every ambulance?

Because of oranges!
 

This is EMS. We need to know if rapid transport with a machine to be resuscitated in the hospital improves survival when compared with resuscitating patients on scene.
 

Perhaps the idea of replacing a human being with a machine to save a life is unsettling.[1]

 

Allow me to rewrite that –

Perhaps the idea of replacing a human being with a machine to save a life transport a dead body is unsettling.
 

But the science doesn’t lie. If we’re going to save more victims of cardiac arrest, we have to overcome all obstacles and embrace the value—and effectiveness—of technology.[1]

 

Then show how this saves lives.

Where is the evidence of improved survival to discharge?

Surrogate endpoints lie.

This is just a surrogate endpoint paper.

This is just a lie with bad science.

What next? Scientists sat, this one trick will cure cancer.
 

Blood-letting is an excellent treatment – based on surrogate endpoints.

Should we go back to bleeding patients to death just because it makes the surrogate endpoints look good?

Footnotes:

[1] Mechanical CPR Could Save More than the Patient’s Life
Karen Wesley, NREMT-P | Keith Wesley, MD, FACEP
December 2013 Issue | Tuesday, December 10, 2013
JEMS
Article

[2] EMS: The low information voters of healthcare – Making decisions purely on emotion and superficial knowledge
September 02, 2013
The Ambulance Driver’s Perspective
by Kelly Grayson
EMS1.com
Article

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Comments

  1. And this is why all the good people leave EMS. Because those that are in charge make idiotic decisions like this and no one will stand up to them that can change anything. So they find another way to make it through life without having to endure this idiocy.

  2. I was a little disappointed that Dr Wesley didn’t respond to the comment I left at the site. I’ll reproduce it here.

    “Mechanical CPR devices have never been shown to save lives, so I think the title of this article is a little misleading. This is especially true given the results of the recent LINC trial (http://jama.jamanetwork.com/article.aspx?articleID=1774037).

    ‘Among adults with out-of-hospital cardiac arrest, there was no significant difference in 4-hour survival between patients treated with the mechanical CPR algorithm or those treated with guideline-adherent manual CPR.’ “

  3. Actually, this study looks like it is comparing apples with apples. Human CPR in a moving ambulance vs machine CPR in a moving ambulance. Whether or not CPR in a moving ambulance is appropriate or not is an entirely different question.

    (However, if you look at the results from the trial of ECMO at The Alfred hospital in Melbourne for patients who have been transported with CPR going, there may be cause for it)

    In any event, my service rightly or wrongly (probably wrongly) transports people while doing CPR, and the mechanical CPR device means that effective compressions do happen during this process and my back hurts a lot less. Anecdotal maybe…..

  4. Such devices do give a new meaning to the phrase, “mechanically recovered meat”.

  5. Who cares about the technical aspects?…if it was YOUR loved one, would any of that matter? Good Grief! Do ANY and ALL you can for as long as it takes!! TOO BAD you don’t have me in your corner……….I would NEVER give up! Been there, turned around, went back, re-thought it, did it again the other way, lived it, both sides, THE END=DON’T GIVE UP.

    • metrolady,

      At some point you need to face reality. Most people will not be resuscitated.

      We need to do what is best for the patients and the families. Continuing to act as if there is hope for a good outcome, when there is not, is dishonest and extremely expensive for the family.

      It is easy to say Never give up. It may feel good.

      Resuscitation is not for us. Resuscitation is for the patients and their families.

      False hope is what alternative medicine promotes, but it is not real. We need to stick to what is real.

      .

  6. Sadly rogue you are of those of us on the ground. She on the other hand does a spectacular job representing both management and medical direction in most EMS systems. And that’s what is wrong with us.

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