>
> John, I still have an AMBU ACD device in my training room but
> it has been
> unused for over 6 years.
>
> It seemed to to drop out of fashion as it was hard work &
> studies showed
> little advantage (?Canadian sources). Except in Paris where the SAMU &
> pompiers adopted it enthusiastically. Their studies supported it with
> increased ROSC.
>
This is the problem with the great majority of studies on treatments for
cardiac arrest: ROSC or survival to hospital admission is taken as an end
point. I appreciate that the numbers required to look at neurologically
acceptable discharge from hospital need to be considerably larger, but ROSC
can just mean a prolonged, expensive and unpleasant death and as such is an
adverse event in some patients rather than a sensible proxy. Patients with a
good survival are a subset of those with ROSC. Unless ROSC is confined to
one arm of the study it cannot be said that it predicts which arm will have
more acceptable outcomes. It surprises me that these days RECs still
consider it ethical to conduct a study and journals still print it with
ROSC (instead of survival to discharge with reasonable neurological outcome)
as an endpoint.
Can I plead to anyone conducting reviews (or indeed primary research) to
look specifically at sensible endpoints instead of ROSC or survival to
hospital arrival.
Matt Dunn
Warwick
This email has been scanned for viruses by NAI AVD however we are unable to
accept responsibility for any damage caused by the contents.
The opinions expressed in this email represent the views of the sender, not
South Warwickshire General Hospitals NHS Trust unless explicitly stated.
If you have received this email in error, please notify the sender.
|