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Taj, You are partially correct (!). Their findings were that there was a significant difference for survival to 24 hours (epi 4/20, vaso 12/20, p=0.02) but the survival to hospital difference wasn't (epi 3/20, vaso 8/20, p=0.16). You are correct in that the authors recommended larger multicentre trials to further explore the issue. The European study involves 42 EMS systems in Germany, Austria and Switzerland. They have randomised 650 patients to date and are aiming for 1500 by the end of the year. It is too early for them to see any definitive trends. (based upon email communication from Volker Wenzel who is one of those coordinating the trial.) Andy -----Original Message----- From: The list will be of relevance to all trainees including undergraduates and [mailto:[log in to unmask]]On Behalf Of Taj Hassan Sent: 28 January 2001 12:52 To: [log in to unmask] Subject: Re: Resus Guidelines on the Web Andy, I think the results from the German vasopressin study were actually positively significant and that was why it generated some debate at the time - the authors accepted it was a small study however. The problems were the system in which the study was done (physician / anaesthetists with ITU experience in pre-hospital setting (not very generalisable). The question has been subsequently answered by Ian Stiell and colleagues in an in-hospital study - no difference in outcome was attained using vasopressin. I saw an abstract but have not seen the paper or been able to find it on Medline. I would be interested to know the construct of the European vasopressin study that you mention. Remember however that Stiell's group also showed absolutely no benefit for the use of the ACD device in an adequately powered and well designed study. These findings were subsequently reversed by a study from France which was published in the NEJM but attracted much criticism. Funny things seem to happen in European EMS systems!!? Taj --- Andrew Lockey <[log in to unmask]> wrote: > 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* ===== Dr Taj Hassan Consultant in A&E Medicine Dept of A&E Medicine Leeds General Infirmary Leeds LS1 3EX, UK Work email: [log in to unmask] Tel : (0113) 392 6470 Fax : (0113) 392 2810 __________________________________________________ Do You Yahoo!? Yahoo! Auctions - Buy the things you want at great prices. http://auctions.yahoo.com/