The cardiac literature 2009

Abstract

Despite the widespread use of cardioactive medications, such as vasopressors and antiarrhythmics, in the resuscitation of cardiac arrest victims, there is actually very little evidence to support these therapies. On the contrary, a recent multicenter center study demonstrated that the use of intravenous medications that are advocated in standard advanced cardiac life support (ACLS) guidelines was ineffective at improving survival of patients with out-of-hospital cardiac arrest [1]. Olasveengen and colleagues now add further support to the contention that the use of intravenous medications in victims of nontraumatic cardiac arrest is not associated with improvements in meaningful outcomes. The authors performed a prospective randomized trial of consecutive adults with nontraumatic cardiac arrest that were treated within their emergency medical services (EMS) system in Oslo between 2003 and 2008. Patients were randomized to either receive standard ACLS therapies with intravenous drug administration (IV group) or ACLS therapies without any intravenous drugs (no IV group). A total of 851 patients were included in the study, 418 patients in the IV group and 433 in the no IV group. The researchers found there was an increase in survival to hospital admission with return of spontaneous circulation in the IV group vs the no IV group (32% vs 21%; P b .001); importantly, however, there was no difference between the groups with regard to survival to hospital discharge (10.5% vs 9.2%; P = .61), survival with favorable neurologic outcome (9.8% vs 8.1%; P = .45), or survival at 1 year (10% vs 8%; P = .53). The results demonstrate that with the use of IV ACLS medications, patients simply die in the hospital rather than at the scene or in the emergency department (ED). Practically speaking, this amounts to increased intensive care unit bed use, hospital resource use, and expenses—yet without any increase in meaningful survival. In this era of ED and hospital overcrowding