March 2019 Journal Club

Hi Guys

Please find attached this month’s paper

https://www.nejm.org/doi/10.1056/NEJMoa1806842

 

It’s a bit less esoteric that last months ūüôā

Cheers

Rob

Hi Everyone

So this was the PARAMEDIC2 study which was designed to identify whether 1mg iv adrenaline administered during CPR conveyed a survival advantage over placebo, all else being equal. Or as the authors put it whether it was “..beneficial or harmful..”

The main outcome was that there was a statistically significant survival advantage if you are administered adrenaline.

However the number needed to treat¬†(NNT)¬†to¬†prevent one death after OOHCA¬†was 112, which is not brilliant. To put it into context bystander CPR has a NNT of 15 and AED a NNT of 5…..

Furthermore that survival advantage comes at a cost. You are more likely to survive but also far more likely to have significant neurological impairment. An outcome that is frequently cited as undesirable in patient surveys.

 

So what conclusions can we draw about the outcome of the study?¬†Is adrenaline “harmful” or “beneficial”?

You could say that because we continue to use it the consensus must be that it is beneficial, however if all we are doing is increasing the likelihood of an outcome that few people actually want then surely the opposite is true?

For now it remains upon the ALS algorithms and therefore represents best practice, so you would be criticised for deviating from this, however I feel it does add ethical weight to the decision to stop CPR in situations where there has been no ROSC despite multiple boluses and cycles of CPR. However, as with everything in life, every case is different and should be judged as such…

What do you think?

Cheers

Rob”

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