Transporting an Arrest, Question on a Call

[MrJones]

Do you have a source for that?

If you have access to Google Scholar (or any other academic search engine), do a search on "airway cuff pressure and cerebral perfusion" and you'll find plenty of sources. I'll even help you get started:

http://emcrit.org/wp-content/uploads/2012/06/segal-sga.pdf

 

[gotbeerz001]

Do you have a source for that?

...

 

[Carlos Danger]

If you have access to Google Scholar (or any other academic search engine), do a search on "airway cuff pressure and cerebral perfusion" and you'll find plenty of sources. I'll even help you get started:

http://emcrit.org/wp-content/uploads/2012/06/segal-sga.pdf

You misunderstand. I was wondering if Tigger had a source to support the idea that SGAs can negatively affect outcomes in humans.....the study you linked to doesn't show that at all.

The Segal study shows that when you take a tiny sample (9) of pigs, give them a cocktail of drugs that can have confounding effects on their cerebrodynamics (ketamine, propofol, isoflurane), and repeatedly instrument their airway with devices that were not designed for their anatomy, you get a reduction in carotid blood flow that may be clinically significant. While it makes an interesting point and suggests that this should be looked at in humans, it doesn't even begin to mean that SGA's impair survival or neurological outcomes in humans.....heck, it didn't even show impaired survival or neurological outcomes in the pigs.

What I find much more compelling than a tiny study done in animals is a very large (n=5,377) outcome study done in humans. When they did that in Japan, they found zero difference in outcomes between OHCA patients treated with ETI vs. SGA. Other studies have similarly found no advantage to ETI. That probably would not be the case if SGA's did, in fact, cause a clinically significant reduction in CBF in humans.

 

[MrJones]

You misunderstand. I was wondering if Tigger had a source to support the idea that SGAs can negatively affect outcomes in humans.....the study you linked to doesn't show that at all.

The Segal study shows that when you take a tiny sample (9) of pigs, give them a cocktail of drugs that can have confounding effects on their cerebrodynamics (ketamine, propofol, isoflurane), and repeatedly instrument their airway with devices that were not designed for their anatomy, you get a reduction in carotid blood flow that may be clinically significant. While it makes an interesting point and suggests that this should be looked at in humans, it doesn't even begin to mean that SGA's impair survival or neurological outcomes in humans.....heck, it didn't even show impaired survival or neurological outcomes in the pigs.

What I find much more compelling than a tiny study done in animals is a very large (n=5,377) outcome study done in humans. When they did that in Japan, they found zero difference in outcomes between OHCA patients treated with ETI vs. SGA. Other studies have similarly found no advantage to ETI. That probably would not be the case if SGA's did, in fact, cause a clinically significant reduction in CBF in humans.

No, I don't misunderstand. What I provided was a start point for your own research on the topic, and suggestions on where to look for further information. Tigger will or won't provide his sources as he sees fit, but I've always found it most effective to do my own literature search in order to answer my specific questions.

 

[Carlos Danger]

No, I don't misunderstand. What I provided was a start point for your own research on the topic, and suggestions on where to look for further information. Tigger will or won't provide his sources as he sees fit, but I've always found it most effective to do my own literature search in order to answer my specific questions.

Well, you definitely seem to have misunderstood at least two things: You misinterpreted my asking for a source as meaning I didn't know how to do a search, and you also apparently thought I wouldn't notice or respond to your condescension.

It's very common and acceptable in the world of academics and evidence-based medicine to ask for sources to support claims or recommendations. It isn't rude, it doesn't mean you doubt the person making the claim, and it certainly doesn't mean you don't know how to do a lit search. It means you assume that the person making the claim has a reasoned and factual foundation for their opinion, and you'd like to learn more about that foundation.

Or, as in this particular case, it could mean that you are already well acquainted with the research on the topic at hand, and wonder if they have come across a source of information that you haven't.

 

[MrJones]

Sorry that you took it that way. And, since I don't want to risk any further misinterpretations (not to mention hand-slaps from the mods) , it's probably best if I avoid future interactions with you.

 

[Bullets]

The literature does not reflect scoop and run because the hospitals are running the same ACLS protocols that are being run in the field.

Japan pretty much runs scoop and run in their EMS system....seems like they have pretty poor outcomes, is this a consequence of scoop and run, or epi as this was studying? I know it doesnt paint the whole picture, but its a start

http://jama.jamanetwork.com/article.aspx?articleid=1105081

 

[Carlos Danger]

Sorry that you took it that way. And, since I don't want to risk any further misinterpretations (not to mention hand-slaps from the mods) , it's probably best if I avoid future interactions with you.

My apologies if I took your post the wrong way.

 

[Tigger]

I didn't post the source originally as I only had a paper copy from a airway lecture. As it turns out, it's the same study that Remi is citing, and those confounding variables (drugs) were left out entirely by the instructor. So I'll eat some of my words on that one. As stated, it still raises questions about the efficacy of those airways.

Not to mention as far as I am aware there is no literature regarding ETI in out of hospital cardiac arrest in which the study actually made sure that the procedure was done properly. Of course the outcomes will be worse if you pause CPR for 30 seconds to intubate.

And for the record, I find it entirely appropriate to ask for citations when someone makes a claim. I would have cited the study if I had it with me, and welcome challenges to do so as should we all. The questioner should not have to do their own research to find the study someone is citing. That's not how it works in academia either. I cannot count the times I made an assertion in college and was told to either cite it or disown it, which is absolutely fair. It is my opinion that if you state "the literature shows..." you better be prepared to actually provide the literature. I'm not going to put a link up every time because frankly I am lazy and don't have many saved in accessible places. But I will find my evidence, or not as the case may be.