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Tinkering with CPR, blood substitutes

The CPR basics of pump-and-breathe keep getting refined.

While investigating the usefulness of a medical device, a team of researchers noticed that paramedics were giving too many breaths to patients when administering CPR, said the study published electronically on Monday by the journal Circulation.

(The headline of this article is misleading. It isn't that "too much CPR" is a bad thing; it's that performing CPR less than optimally is, well, less than optimal.) We keep learning more about what "optimal" really is.

ACLS keeps being tinkered with too. Vasopressin now seems all the rage:

Vasopressin use among patients with post-event asystole, however, was associated with significantly higher rates of hospital admission and hospital discharge. For these patients, use of vasopressin rather than epinephrine conferred about a 40 percent greater likelihood of survival to admission.

And paramedics in Denver are now carrying the blood substitute PolyHeme:

“We are pleased that patient enrollment in this ambulance trial with a blood substitute may now begin,” said Ernest E. “Gene” Moore, M.D., Chief of Surgery and Trauma Services, Denver Health’s principal investigator. “This study could potentially lead to a change in the initial treatment of critically injured and bleeding patients that may result in improved survival.”

All in all, it seems like a great time to be in emergency medicine!

Comments

Read between the lines of the first two studies. There are real gremlins waiting to bite there.

Now here's something that actually helps survival of post-arrest patients

http://www.medscape.com/viewarticle/458347

Whoa! There is a blood substitute? Then why do I crack a vein once every 8 weeks to give up my precious O Neg Liquid of Life?

The studies are weak. Which makes me wonder about how the media makes decisions about reporting medical research. The CPR study is a great example, both the article I linked to and the one in the New York Times. Misleading headlines, and coverage of insignificant results. Why?

Jkrasch: you're O-neg? Congratulations! (And simultaneously, please accept my condolences...)

:)

Lutheran is starting a program where, if the call is cardiac and the paramedic gets a possible cardiac problem off the 12-lead, they can call in and assemble the cath team before they reach the hospital. Apparently a few other hospitals have tried it and, while at first the success rate on actual cardiac problems was 50%, it's now up to over 90% and it's getting people in to the cath lab an hour sooner. Highland is going to start in a few months after they've done a test run with Pridemark.
Highland is also about to get epi pens for EMT's to use on first time anaphalaxis patients (since that's what most of them are that we'll get called to). Yay more drugs for me to administer that I can carry with me!!

As an EMS junkie, I love to see the scope of paramedic practice expanded in ways which really help, as the Lutheran program seems to. The bonus is that it makes practicing as a paramedic more fun.

Same goes for EMTs, and epi pens. Everyone always worries about the risk of misadministration, but with solid training and rational protocols, I don't think this has to be a problem. The key, as always, is to get competent people out on the streets, and then support them as vital components of the whole emergency medical system.