Craig,
I agree - remember however that the guidelines have been recommended
internationally and the ERC and then RC(UK) have taken on board those that are
applicable to the UK. I agree that the initial data on vasopressin is
promising however the paper on which this recommendation is based consisted of
only 20 patients in the two limbs and the results were not statistically
significant. There is however a large ongoing european study with results due
later this year which may lend greater support to its use. Incidentally, I
totally agree about the lack of convincing evidence about amiodarone. The
pre-hospital paper from Seattle on which it was mainly based is not watertight
and did not show any evidence of statistically significant increased survival
to hospital discharge.
Whilst there is anecdotal evidence/experience, it is difficult to totally
remove drugs from the recommendation in this end-stage desparate situation.
Remember that these are GUIDELINES and that those drugs with a lesser evidence
base are included as "CONSIDER x,y,z" (and that includes amiodarone in the
updated universal algorithm).
Andy
>===== Original Message From The list will be of relevance to all trainees
including undergraduates and <[log in to unmask]> =====
>Its interesting that the RC(UK) have found there is not enough evidence to
support the use of vasopressin in adult VF/VT arrests, but there is to
recommend the use of amiodarone. My reading of the literature is that the
evidence is actually stronger for vasopressin than for amiodarone.
>
>Then they goes on to say. There is no evidence to support any drugs at all in
cardiac arrest, but we recommend x,y,z. When do you think someone will be
brave enough to remove drugs from the arrest algorithms altogether? Do you
think it will ever happen ? ( assuming the body of evidence doesnt sudden show
us the light )
>
>Any thoughts ?
>
>Craig
>
>Dr Craig Ellis
>Registrar in Emergency Medicine
>Wellington Hospital
>Wellington, New Zealand.
>
>
>>> [log in to unmask] 01/25/01 10:50 >>>
>For those interested, the 2000 Guidelines (for adult, paediatric and
>neonatal basic and advanced life support in the UK) are now accessible via
>the Resuscitation Council (UK) website at www.resus.org.uk/pages/guide.htm
><http://www.resus.org.uk/pages/guide.htm>
>
>
>
>
>
>
>CCH Secure Mail Server
>*****************************************************************************
***
>This email or attachment(s) may contain confidential or legally privileged
information intended for the sole use of the addressee(s). Any use,
redistribution, disclosure, or reproduction of this message, except as
intended, is prohibited. If you
>received this email in error, please notify the sender and remove all copies
of the message, including any attachments. Any views or opinions expressed in
this email (unless otherwise stated) may not represent those of Capital Coast
Health Ltd.
>(AC_S001)
>
>
>[INFO] -- Virus Manager:
>No Viruses were detected in this message.
>
>*****************************************************************************
***
Totalise - the Users ISP
----------------------
To become a member and a shareholder - visit the site at
www.totalise.co.uk
-----------------------
***Would you like to save up to 28% on your gas and electricity bills!***
*Visit http://www.totaliseshop.co.uk/html/buy.co.uk/buy_frameset.htm*
|