Christmas in July?
Unfortunately no, but this story had me going. Turns out that EMS agencies in Portland, Oregon are going to be studying “whether cardiac arrest drugs help or hinder”. That headline gave me hope that we were finally studying if all the ACLS drugs benefited or harmed patients when looking at neurological outcomes. Turns out we’re not. We’re studying whether Amiodarone, Lidocaine, or a placebo results in better outcomes. Now don’t get me wrong, this is a step in the right direction. Now that being said, the article references the fact that research has already shown Amiodarone to be no more effective than a placebo. But, if memory serves, that study looked at ROSC, not neurologically intact outcome. That being the case, this study IS moving in the right direction.
My question remains, however, why can’t we do the same study with epinephrine? On the face of it, this study protocol appears to be one which could be easily transferred to epinephrine. Using syringes marked only with a barcode so that researcher can later link a certain medication or a placebo to a given patient. When I started reading the article comments, however, I realized why we can’t study epinephrine. We haven’t bothered to teach the public. Heck, we haven’t even bothered to teach the medical community. Many of the comments, including some from those who identified as medical professionals, launched into tirades about lawsuits resulting from withholding “standard care”. The fact is, as long as people (both those in the public and the medical community) assume that our “standard” treatments are based on facts, our hands will be tied. This dedication to tradition for tradition’s sake may be killing our patients.
We are forced to follow outdated modes of treatment because we haven’t taken the time to educate our own communities about what those treatments are based on. While there will always be a subset of the population unwilling to participate is these types of programs, aggressive public (and medical) education campaigns may help to mitigate some of those issues. Researchers are offering the public free “No Study” bracelets if they want to opt out. It will be interesting to see, when all things are said and done, how many took them up on that offer and if they have trouble getting an acceptable sample size.
What do you think? What would be the most effective design for a study looking at the benefit or harm of ACLS drugs? Should patients or family have to consent for this type of study? How can we effectively educate the public about why and how we treat them? Do you work for one of the agencies in this study? Let me know in the comments.