ERDoc Posted December 13, 2014 Share Posted December 13, 2014 (edited) it is most effective and has the highest benefit when given early I think that is the most important part. A 5cc saline bolus will probably be shown to improve outcomes if given soon enough. At some point, dead is dead. The problem is there is no way for us to know when that is so we have to go through the motions. Edited December 13, 2014 by ERDoc Link to comment Share on other sites More sharing options...
rock_shoes Posted December 13, 2014 Share Posted December 13, 2014 I think that what you'll see is either a intubation study (maybe, but if some groups dropped out that could, and hopefully WOULD kill that study) or one done on various doses of epinephrine. My personal opinion only on the latter but...wouldn't surprise me. Sure you did. I have been hearing from our ROC coordinator that an epi trial is on the radar. What exactly that will look like is the real question. Personally I'm hoping for a three pronged RCT to start (0 versus 500mcg/dose versus the current 1mg/dose). One of the other questions is method of administration. Maybe we should be running infusions to achieve steadier levels of the drug versus the monstrous bolus doses we currently push. Link to comment Share on other sites More sharing options...
mikeymedic1984 Posted December 13, 2014 Share Posted December 13, 2014 I am glad you think your are an adult triemal, but to discount real life experience versus what you read in a book, is not very mature. I read that Obama is an alien from mars, and that Bush was a puppet of the Luminatie. I also read that the earth is flat, and that the menstral cycle can be cured with leaches. Real life would suggest a different reality. I had far more ROSC under the ACLS protocols (not my protocols) of the 80s, versus what is offered today. If you practiced under those protocols, then please provide your real life accounts of why they were wrong. Link to comment Share on other sites More sharing options...
ERDoc Posted December 13, 2014 Share Posted December 13, 2014 Anecdote is not evidence. Link to comment Share on other sites More sharing options...
rock_shoes Posted December 13, 2014 Share Posted December 13, 2014 I am glad you think your are an adult triemal, but to discount real life experience versus what you read in a book, is not very mature. I read that Obama is an alien from mars, and that Bush was a puppet of the Luminatie. I also read that the earth is flat, and that the menstral cycle can be cured with leaches. Real life would suggest a different reality. I had far more ROSC under the ACLS protocols (not my protocols) of the 80s, versus what is offered today. If you practiced under those protocols, then please provide your real life accounts of why they were wrong. I don't think the point being made was that those protocols were necessarily ineffective. The point was that they had little evidence behind them. Spiking glucose levels for example has been proven to be harmful in several different varieties of brain injured patients. By extension we can suspect that administering D50W to a cardiac arrest probably won't have a positive effect on that patients neurological outcome. Without, to my knowledge, having studied it perhaps glucose increases ROSC. The real question though is whether or not that's truly beneficial if the glucose cooks what's left of the patient's brain. ROSC workout neurological recovery is irrelevant to the patient and worse for the patient's loved ones. Link to comment Share on other sites More sharing options...
triemal04 Posted December 13, 2014 Share Posted December 13, 2014 I think that is the most important part. A 5cc saline bolus will probably be shown to improve outcomes if given soon enough. At some point, dead is dead. The problem is there is no way for us to know when that is so we have to go through the motions. It is. That was the biggest thing I got from the large study from japan a couple years ago; it's not that epi is inherently bad (which was their conclusion for some reason) just that it doesn't lead to good outcomes unless it's given in a timely manner after starting a resuscitation. Strange thought, no? Small steps...hopefully one day we'll get there. Of course that really requires a cultural change more than anything medical, but maybe some day... I have been hearing from our ROC coordinator that an epi trial is on the radar. What exactly that will look like is the real question. Personally I'm hoping for a three pronged RCT to start (0 versus 500mcg/dose versus the current 1mg/dose). One of the other questions is method of administration. Maybe we should be running infusions to achieve steadier levels of the drug versus the monstrous bolus doses we currently push. I would think (hope) it would be something like that; have a 20cc vial and draw up either a ml of saline, or a ml of x mg/ml or y mg/ml. Be interesting to see what would happen with a drip. It's worth remembering that epi doesn't function well in acidotic environments, and given that the pH of the average arrest is something like 7.1 (I think, it was relatively low) a heavier concentration for a drip than normal might be required. Be interesting to see, but I think it'd be better to figure out just how much and when epi should be used in the first place, then look at the way it's given. Of course, given the howls that went with the ALPS study, an epi study that includes a placebo arm (which it has to) will cause a lot of blowback from some providers. Some of the press releases that went with the Paramedic2 study seemed to be aimed more at paramedics than the public... Thanks for proving my point mikey...if you want, I bet there's lots of places that would love to publish a scholarly article about your personal anecdotal experience...you should contact them. Link to comment Share on other sites More sharing options...
mikeymedic1984 Posted December 15, 2014 Share Posted December 15, 2014 Well unfortunately the internet was not available in the 1980s, so I am sure you can request info from each university that did a study. But I would remind you that all ROSC rates have pretty much been stagnant for the past two decades, so before you write me off as an idiot, maybe you should look up the rosc rates over the past three decades, do some research, and show me that I am just a medic with alzhiemers. I hate to be the one to tell you, but in 70's-80's ems, there was not alot of controlled scientific studies. But as stated, this generation has not improved ROSC, no more than we did in the 60's, despite all your studies, so who is the fool ???? Link to comment Share on other sites More sharing options...
ERDoc Posted December 15, 2014 Share Posted December 15, 2014 I would say just the opposite Mikey. All of the studies have shown one thing, although not explicitly. Time is one of the most important factors. We could develop the miracle drug that will convert everyone into a sinus rhythm, but if we can't to them in time, it is still useless. Link to comment Share on other sites More sharing options...
rock_shoes Posted December 15, 2014 Share Posted December 15, 2014 Actually Mike, both ROSC and survival to discharge rates have improved. The amount of improvement varies significantly by service with services like BCAS (metro operations) and Seattle/King County leading the pack. One of the biggest improvements so far was the re-emphasis of timely quality chest compressions (which was in fact a throw back from the 60s). ROSC & survival to discharge rates have waxed and waned a number of times over the years. I expect them to continue to do exactly that with a general upward trend over the long term. To say that we've learned nothing over the past 50 years of cardiac arrest management would be ignorant. Link to comment Share on other sites More sharing options...
mikeymedic1984 Posted December 16, 2014 Share Posted December 16, 2014 Oh we have learned something, and it has been elegantly stated in this forum. We have learned that changing what drugs we give every 4 years is a waste of time, and that if we could figure out a way to get help to people faster (like Seattle/King county) many more people would survive, But for some reason, we just can't seem to find the money to do that. We can find all kinds of money to build new sports stadiums though. Link to comment Share on other sites More sharing options...
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