> With regard not transporting patients to A&E in arrest - I think that very
> suspect clinically - yes I know - survival low, efficacy poor etc etc but
> some do survive and it is often likley to be socially unaccepatable to the
> punters. What do the A&E wallahs think? I certainly know of some who say
> that ALL patients have not had the full works until the A&E boys have had
> their fun.
That's not what the evidence shows. There is very little, if anything, of
value that you can do in A+E in a standard medical cardiac arrest that you
cannot do at the scene.
In fact the real truth is that if you can't shock them back within the first
few cycles then they are statistically pretty much done for (as others have
pointed out - the NEJM study was the most depressing one!). I personally
don't think the risks involved in emergency driving with one crew member
doing CPR justify the miniscule chance of recovery.
This is especially true when you realise the harm this does to relatives who
have to see their loved one rushed off at high speed and then have to follow
up to be given the bad news at hospital. Also, in some cases a doctor
simply pronounces death in the back of the ambulance on arrival (but dont
get me started on that!).
Far better to manage the arrest at the scene.
However, I stress this is for straightforward medical arrests - NOT cardiac
arrests in special circumstances (trauma, asthma, pregnancy, drowning,
poisoning, electrocution, anaphylaxis, children etc) and if your going to
quote me make sure you mention that!
As has been said, if the patient arrests again en route, it is best to stop
the ambulance and continue rx there and then.
Robbie Coull
email: [log in to unmask] website: http://www.coull.net
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