From the pre-hospital literature: Not yet time to change our ways

Christopher, Sarah (2009) From the pre-hospital literature: Not yet time to change our ways. Emergency Medicine Journal, 26 (3). p. 219. ISSN 1472-0205

Full content URL: http://emj.bmj.com/content/26/3/219

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Item Type:Review
Item Status:Live Archive

Abstract

There has long been debate over the efficacy of intravenous drugs in cardiac arrest. This observational, prospective study set out to investigate whether the introduction of a single dose of 1 mg intravenous epinephrine improved outcomes from prehospital cardiac arrest in an emergency medical service that did not previously use this drug. Outcomes examined included survival to discharge, survival to hospital admission, return of spontaneous circulation and functional status on discharge. Although the authors state that they were unable to establish a survival benefit with the introduction of intravenous epinephrine to this emergency medical service, many unmeasured confounders were not accounted for. The study examined the effect of only a single dose of epinephrine until after arrival at hospital and no other drugs such as amiodarone or lignocaine were given. It was admitted that there was a relatively low success rate of intravenous drug delivery and variations in post-resuscitation care were not accounted for. This study highlights the importance of designing prehospital studies that are methodologically robust, if questions about the efficacy of interventions such as medical devices or drugs are to be answered definitively. Adequately powered randomised controlled trials may be difficult to conduct in this setting but are not impossible and remain the gold standard.

Eng Hock Ong M, Hoe Tan E, Suan Peng Ng S, . Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest. Ann Emerg Med 2007;50:635–42.

Keywords:Emergency medical services
Subjects:B Subjects allied to Medicine > B990 Subjects Allied to Medicine not elsewhere classified
L Social studies > L510 Health & Welfare
Divisions:College of Social Science > School of Health & Social Care
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ID Code:28907
Deposited On:05 Oct 2017 09:03

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