January 21, 2016

One of the major reasons contributing to dismal survival rates in out-of-hospital cardiac arrest (OHCA) is the lack of bystander initiated cardiopulmonary resuscitation (CPR). Even though the majority of OHCA is witnessed, only 1 in 5 patients will receive bystander initiated CPR [1].  Survey studies have shown that bystanders are not wanting to do mouth-to-mouth resuscitation on strangers. Outside of early defibrillation, only early bystander initiated CPR has consistently been shown to improve neurologically intact survival in OHCA. So what about  Cardiocerebral Resuscitation, also known as "Hands-Only" CPR?

January 14, 2016

 

The Ontario Prehospital Advanced Life Support (OPALS) Study

Background: Sudden cardiac arrest is common and, obviously, very bad. In the US, there are about 500,000 cardiac arrests each year. About half of these cardiac arrests are OHCA and the survival rate is pretty poor. The most recent survival estimates put it at 7 – 9.5% in most communities. About 10-12 years ago, the American Heart Association built the 4-step “chain-of-survival.”
  • Step One - Early access to emergency care
  • Step Two - Early CPR
  • Step Three – Early defibrillation
There is little debate about these three steps as the sum of the data supports that they lead to better outcomes. The 4th step in the chain, however, is slightly more controversial; early advanced care. This basically means rapid access to ACLS type resuscitation skills (intubation and intravenous drug therapy). Despite it being the 4th step, ACLS has little evidence to defend it. 

April 6, 2015

Welcome to the REBEL Cast Episode 7, where Swami, Matt, and I are going to tackle a couple of articles just published this year. Today we are going to specifically tackle:
  • Topic #1: Basic Life Support (BLS) vs Advanced Cardiac Life Support (ACLS) in Out of Hospital Cardiac Arrest (OHCA)
  • Topic #2: PROMISE Trial - Anatomic vs Functional Testing for Coronary Artery Disease (CAD)
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