Much is being made of a study being reported at the website Health Day.
Here is the lede,
MONDAY, Nov. 24, 2014 (HealthDay News) — Advanced life support given by paramedics to cardiac arrest victims may cost lives rather than save them, researchers report.
The best treatment might just be good CPR given by paramedics or emergency medical technicians and getting the patient to the hospital as fast as possible, the Harvard University researchers noted.
Oh my, this is earth shattering news. Well, not really. Not only is the news that good CPR and early defibrillation are the keys to survival, it’s not news. The American Heart Association has been saying this for about ten years.
What this article doesn’t tell us, is that patients that do not achieve Return of Spontaneous Circulation (ROSC) at the scene have a far worse chance of survival than those who do achieve ROSC.
The article also doesn’t mention that patients in Ventricular Fibrillation or pulseless Ventricular Tachycardia have a better chance of ROSC than patients who present in Asystole.
All of this has been studied for about 20 years. EMS systems that track their cardiac arrest survival rates use the Utstein Template to enter and track data. The Ustein Template only tracks V-Fib and pulseless V-Tach because Asystole has a very, very low survival rate.
Many EMS systems are taking a CPR and AED first approach for the initial treatment of cardiac arrest. When it works, which is much of the time, it works well. What this “study” doesn’t tell is what happens when it doesn’t work. What magic takes place in the Emergency Department that isn’t done in the field? From what I’ve seen, none.
The study doesn’t seem to take into account the survival of patients who do achieve ROSC in the field. Once that happens, there are a number of things that paramedics can do that EMTs can’t do that benefit the patient.
Airway control and controlled respiration with the goal of not over oxygenating the patient and driving down CO2 levels in the brain are one. Therapeutic Hypothermia is another. Support of blood pressure is a third. All play a important role in survival to discharge with good neurological function.
For the study, Sanghavi and her colleagues used a large sample of Medicare claims for ambulance services in urban areas between 2009 and 2011.
Medicare claims wouldn’t seem to me to be the best source of detailed medical data upon which to base a study, but maybe I’m wrong.
I’d want to see a much better designed study before I’d be convinced that the benefits of using only BLS and rapid transport outweigh the risks of driving dead people to the hospital at a high rate of speed so that doctors can do the same thing that the paramedics could have done 20 minutes sooner.
I’ll have comments on another “study” from Health Day News tomorrow or Monday.