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MSM Podcast Ep. 5- Cardiac Arrest: We have no idea what we’re doing

We think we know. We keep trying new techniques and using new tools and toys, and perhaps that’s our downfall. We know that mechanical CPR is, at best, a questionably effective tool. We use drugs that don’t make a lot of sense, physiologically, to give to cardiac arrest patients. When we use new tools that we think will work (like the impedence threshold device), we find that they don’t work. It seems that with each new study and data set that comes out, we find that we know less and less.

The variability in out-of-hospital cardiac arrest survivability is vast. In Seattle, the “crown jewel” of EMS agencies, OHCA survivability is over 22 percent. Compared to cities like Detroit, where the survivability is 3 percent, it seems like Seattle is simply doing it better. But what is Seattle doing so differently? Is there EMS system so much better than others that people in the great American Northwest just have a better chance of surviving? It seems that the most likely reason is by-stander training. Citizens of Seattle seem to gravitate more toward lay-person CPR training than, say the people of New York City.

But by-stander CPR, and CPR in general, is something that we’ve always known helps survivability. Is there anything that we do in the pre-hospital environment, or even in the hospital that tangibly improves outcomes? What about fancy new technologies like ECMO or therapeutic hypothermia? Do they work or improve outcomes? We know that hypothermia may not be beneficial, and that ECMO is probably years away from being implemented for paramedics. But perhaps part of the problem is that we don’t do CPR long enough. There are a lot of variables that we simply haven’t found an answer for.

Paper of the week

Nebulized fentanyl vs intravenous morphine for ED patients with acute abdominal pain: a randomized double-blinded, placebo-controlled clinical trial

Deaton, Travis et al.

The American Journal of Emergency Medicine , Volume 33 , Issue 6 , 791 – 795

Medbox: You Are Not So Smart by David McRaney