Is Oregon study still on (prehospital cardiac drugs)?

If a drug is found to be ineffective or harmful, it needs to be discontinued at once.

If it isn't, you use it.

If it isn't and you use it normally but you start giving a blind test between a drug that you use and presumably works and a known placebo (saline), you are randomly withholding treatment. Your index of suspicion that the older drugs don't work has to be pretty high to do that.

Damned if you do, and vice versa.
 
mycrofft said:
If a drug is found to be ineffective or harmful, it needs to be discontinued at once.
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Amiodarone and lidocaine, according to the best evidence available, are ineffective in changing any important outcome, like survival to discharge or neurologically intact survival. Yet we still use them...
Seems like ALPs is answering an important question.

_____

Harrison EE. Lidocaine in prehospital countershock refractory ventricular fibrillation. Ann Emerg Med 1981;10:420-423. (Retrospective; 116 patients)

Weaver WD, Fahrenbruch CE, Johnson DD, et al. Effect of epinephrine and lidocaine therapy on outcome after cardiac arrest due to ventricular fibrillation. Circulation 1990;82:2027-2034. (Unblinded, randomized; 199 patients)

Herlitz J, Ekstrom L, Wennerblom B, et al. Lidocaine in out-of-hospital ventricular fibrillation. Does it improve survival? Resuscitation 1997;33:199-205. (Retrospective cohort; 1212 patients)

Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002;346:884-890. (Randomized, double-blind; 347 patients)

via Evidence Based Medicine (Unfortunately I don't have enough posts to give the link, but it will show up with a quick google search for ebmedicine. Try to ignore all the paid subscription stuff.)
 
jkc said:
Amiodarone and lidocaine, according to the best evidence available, are ineffective in changing any important outcome, like survival to discharge or neurologically intact survival. Yet we still use them...
Seems like ALPs is answering an important question.
Click to expand...

We've always known that though...amiodarone is poorly effective at terminating ventricular arrhythmias OF ALL CAUSES...lidocaine is poorly effective at terminating ventricular arrhythmias OF ALL CAUSES. For many specific types of ventricular arrhythmias they work great. Lidocaine is wonderful for ischemia induced VT. (Wait...you mean there are different types of VT besides monomorphic and polymorphic?!)

It is not surprising that throwing a blanket medication at patients would result in rates not statistically different from placebo.
 
Someone was talking to me about this study not too long ago at a conference I attended. I'm pretty sure our mother company is part of this study as well, but I'll have to ask around...
 
So yeah study, it was a :censored::censored::censored::censored: show when were told that we were doing it.

However frankly in my neck of the woods our ROSC rate is pretty low due to response time due to the rural aspect (esp in Clackamas County). Overall I'm not super opposed to it. If anyone has specific questions I can try to address them.
 
Christopher said:
It is not surprising that throwing a blanket medication at patients would result in rates not statistically different from placebo.
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I'm willing to bet this is what they are aiming to discover.
 
Silverman780 said:
So yeah study, it was a :censored::censored::censored::censored: show when were told that we were doing it.

However frankly in my neck of the woods our ROSC rate is pretty low due to response time due to the rural aspect (esp in Clackamas County). Overall I'm not super opposed to it. If anyone has specific questions I can try to address them.
Click to expand...

Why would anybody be opposed to this study? Or was the fuster cluck getting folks to use the study-kits? Or something else I've missed.
 
When I visit Clackamas and Portland I carry a card refusing the study.
(Go Molalla! No, I mean it....GO).
 
fast65 said:
Someone was talking to me about this study not too long ago at a conference I attended. I'm pretty sure our mother company is part of this study as well, but I'll have to ask around...
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IIRC where you work I would say that is a good possibility. My shop already has a draft protocol for removing EPI from cardiac arrest. I don't know when it goes into effect but it will be soon.
 
rmabrey said:
IIRC where you work I would say that is a good possibility. My shop already has a draft protocol for removing EPI from cardiac arrest. I don't know when it goes into effect but it will be soon.
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Let us know if or when it occurs. Also, that would be a prime opportunity for a "before and after" study, or to reintroduce epi as a double blind placebo-controlled trial. (I won't hold me breath, though.)
 
medicsb said:
Let us know if or when it occurs. Also, that would be a prime opportunity for a "before and after" study, or to reintroduce epi as a double blind placebo-controlled trial. (I won't hold me breath, though.)
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I'm sure a study will happen. Our medical director and QI are very evidence based. We were one of the first to increase response time to prove no change in outcomes. if that gives you any idea how we roll here
 
rmabrey said:
I'm sure a study will happen. Our medical director and QI are very evidence based. We were one of the first to increase response time to prove no change in outcomes. if that gives you any idea how we roll here
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Hold the presses. There is an important thread there. Any article, reports etc to cite? Start a thread rmabrey!
 
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mycrofft said:
Hold the presses. There is an important thread there. Any article, reports etc to cite? Start a thread rmabrey!
Click to expand...

I could ask if there was anything. But I think this was mostly an in house thing over a few years for contract stuff. I know there was a presentation on a similiar study at the Houston conference this year.

Im sure as large as my company is there is something floating around.
 
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