BLS Epi in cardiac arrest?

[Rialaigh]

This is a tempting point of view, but it isn't the right way to look at it.

Getting pulses back with high-dose epi is like starting an old car with a clogged up fuel system by spraying some starter fluid into the intake manifold. You might get it to turn over and catch and run for a few seconds, but you haven't fixed the car at all, or really even done anything to benefit the situation.

When you bring a post-arrest patient to the ED with pulses, all you've done most of the time is spray some starter fluid into the intake. The patient has suffered a a fatal and irreversible injury.

So the question is, why do we bother continuing to spray fuel into the intake and then claim success just because the engine runs for a few minutes?

IMO, it is time for resuscitation science to stop trying to raise everyone from the dead, and start focusing on identifying those few who can benefit from resuscitation.

This

But also

It is time for resuscitation science to stop trying to raise everyone from the dead and work on educating providers on humanely NOT trying to raise MOST of the cardiac arrests we see from the dead...

IMO it is more important and ethical to know when NOT to work a code than to have to deal with making the decision on when to call a code...

 

[Handsome Robb]

Source?

http://www.ncbi.nlm.nih.gov/m/pubmed/22436956/

First google result searching "efficacy of epinephrine in cardiac arrest"

 

[Carlos Danger]

Source?

I replied to you a few posts up with a link to a meta-analysis that indicates as much. They've actually been saying this for decades.

Also, keep in mind that it is the responsibility of the intervention to prove it's worth, not the other way around. Very important thing to remember.

 

[Christopher]

Source?

Holmberg 2002, Ong 2007, Jacobs 2010, and Higihara 2013 all come to mind.

Causal harm? Not proven. Associated harm? Possibly.

Causal benefit? Not proven. Associated benefit? Possibly.

 

[blindsideflank]

http://www.ncbi.nlm.nih.gov/m/pubmed/22436956/

First google result searching "efficacy of epinephrine in cardiac arrest"

btw, when i said source, i hope i didnt come off as rude. i truly would like to see the studies. i am also not disagreeing with you guys, simply playing the devils advocate.

i will read the whole study when i can, but what this tells me is
epi is better for rosc, but of those resuscitated, a higher percent dont survive

so the more salvageable pts (that can be resuscitated without epi) have a higher chance of survival

but did epi save a few that they wouldnt have gotten back without epi? would epi have hurt those they got back without it?

i will read the others tomorrow. my point still stands that post resus care/research may change who we deem as not worth working