First Aid

By Jim McVeagh 13/12/2009

A recent high quality study in the Journal of the American Medical Association shows that the use of intravenous drugs in out-of-hospital resuscitation does not lead to better survival rates – just more admissions to hospital. This is a significant finding for two reasons. First, it emphasises that good quality CPR and early access to a defibrillator are the only things that make any difference to cardiac arrest survival in the community. And the evidence is that good quality CPR, administered as soon as possible, is more effective than standing with your hands in your pockets and waiting for the guys with the heart rebooter. You can’t do any serious damage doing CPR, even if you have never done it in your life. Middle of the chest; press hard; press fast. Simple as that. Oh, and keep your elbows straight and use your weight, otherwise you will get tired real fast.

If you ever find yourself in that very frightening situation, have a go. Neither of you have anything to lose.

The other thing about this study is that it tells us that all the fancy drugs we give in community resuscitation serve only to waste hospital resources, not save lives. This result needs to be confirmed by at least one more study as soon as possible. If it is verified by another study, then all resuscitation drugs should be abandoned in the out-of-hospital situation (I can hear the paramedics complaining already!). The extra 15% of people who survive to hospital admission are consuming expensive hospital ICU resources to no avail. Frankly, if I’m not going to survive anyway, I would much prefer a quick, drop-in-the-street death to a lingering week in ICU having my near-corpse poked and prodded. I suspect most of us feel that way.

As an ED trained doctor, I am enthusiastic about doing your absolute best in a resuscitation situation. But pointless interventions are not only pointless, they are cruel.


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