I thought we were working on Why Can't Medics Intubate?
We still are. This is just a change in perspective. A study, not yet published, but available on line, shows part of the problem with resuscitation.
What is that?
As I have stated many times before, we put the ALS (Advanced Life Support) before the BLS (Basic Life Support). We waste time on ALS, that does nothing good for the patient, at the expense of the BLS. The BLS treatments - continuous compressions and rapid defibrillation - have been shown to work. The ALS, well maybe we should start calling ALS Alternative Medicine Life Support.
We keep making excuses for why ALS does not improve outcomes. Maybe a little homeopathy (pardon the pun), some acupuncture (not on the sternum with the needles), some psychics to talk to the not quite dead, yet . . . .
Ok, OK, what does the study say?
It starts with, SEE EDITORIAL, P. XX., but there is no editorial listed. I think they just realized that this paper would ruffle a feather or two and there will be some ALS apologist will come up with something in a few days.
Editor’s Capsule Summary
What is already known on this topic
Decreased interruption of chest compressions in out-of-hospital cardiac arrest is strongly associated with increased survival in animal models and clinical trials. Little is known, however, about the specific issues that lead to interruptions.
What question this study addressed
What are the frequency and duration of cardiopulmonary resuscitation chest compression interruptions associated with paramedic endotracheal intubation during out-of-hospital cardiac arrest?
What this study adds to our knowledge
In 100 out-of-hospital cardiac arrests, patients' chest compressions were interrupted twice, on average, because of efforts to intubate, with a mean total interruption time of nearly 2 minutes.
How this might change clinical practice
This adds support for the current movement to de-emphasize intubation and delay it until later in resuscitation attempts for out-of-hospital cardiac arrest.
We have been encouraging paramedics to draw people toward the light - the laryngoscope light.
Is there evidence of a benefit of intubation in cardiac arrest treatment?
Intubation in cardiac arrest is as much wishful thinking as epinephrine, lidocaine, bretylium, amiodarone, IV/IO/IC access, et cetera.
Like zombies they follow our voodoo into the ICU as brain dead consumers of massive amounts of resources, but they do not get better.
We know what works - BLS treatments - continuous compressions and rapid defibrillation. We are not satisfied with that, so we come up with things to interfere with the BLS treatments. The above list of ALS treatments have only been demonstrated to be effective at delaying/interrupting/discouraging/interfering with effective treatments.
What has happened to resuscitation rates as ALS has been de-emphasized and more emphasis has been placed on continuous compressions?
They seem to have tripled in most of the places that have cut back on the ALS and emphasized the BLS.
If they were 5%, they are now 15%.
If they were 15%, they are now 45%.
So, why are we still wasting time with ALS?
Maybe we should consider ALS to be a Reversible Cause of continuing Cardiac Arrest.
^ 1 Interruptions in Cardiopulmonary Resuscitation From Paramedic Endotracheal Intubation.
Wang HE, Simeone SJ, Weaver MD, Callaway CW.
Ann Emerg Med. 2009 Jul 1. [Epub ahead of print]
PMID: 19573949 [PubMed - as supplied by publisher]